HomeMy WebLinkAboutMortgage_Riley (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDWESS� Tovmship Year
:.: _
, FOR DEDUCTION FROM ASSESSED VALUATION
State Fartn a3709 (R77 / 6-09) AU 2.4 2011
,,.,. � Presaibetl by DepaRmeM of Lo�al Govemment Fnance
C ,� File Mark
INSTRUCTIONS:
To 6e filed in person or by mail with the CounryAuditor or Counry Recortler oI the aounry wAere fhe property is locat . F� �� ��
FifingDates: iJRealProperty:MUSt�deduringtheyearlorwhichthededucUonissought. GiBSONCOUNTYAUDI O�CpunryAuditor
2) Mo6Ae / Manufactured Homes rrot assessed as Real Properly Must file durirrg the fwelve (12) monfhs
6eto,e March 31 of each year the deduction is sought. County Recorder
See reverse side for additional instructions and qualrficatbns.
Ap t(owner convactbuyer-s re5nrliorssmreversesile)
n�. � � C'��,.ti�, „ (� x 4 „. .
A�essed vahie of reai P�`/ az o�
ifarUt ac�entyrar
/
Ii rw. whaf is his I Mr e�q share o1 inb
It rame on recpd is tliRerent Ihan Na� a
Name W mutgagee or mntract seller
AEdress d mortgagce a contract seDer
num0er / legal desaiDtion
� �-a5-3a- tioo l
Mw�qage / Contract intlebtedness unpaid az af
Martl� 1. a�rtent yePr
mdipte Celow:
or oNer awner or hdEer W mor�gage
��.
c¢y, srare, ara ur ooae)
Reco�d rwmEer Page numDu
� q-oa d � y79
Mort929e / ContraG indehtedness unpaid az of Is Ihe aPdirant Me sole
Eate of appfuation legal w equitade axneR
❑ Yes ❑ No
someone other ihan spousa.
DI'a11'CI' 1�r0
Does applivnt wm pmperty in any aher I( yes. what muntyt Wl�at"
munry in Intliara? C:11�Lj 1�� O. .
_ ❑ Yes ❑ No •..,
perty in VuesCOn: MmuM Assessed
PrOpelly ❑ ArnluaDyASSessSCd
Modle Home (IC G7.1
a••°..°.�.-.
y79�....� �P o
20 � 2b _ � 20 � 20 _ � 20 � 20 � 20
i/ We ceNfy under Ne penal[y of perjury that ihe above and foregoing infortnaUon is W e and cortect and �hat ihe applipnt is a resident o( Indiaria arM
owner I contract buyer of the afwementioned properry on date application is filed.
ee
by IC 61.142-0]
person (numbera� sfreef, Uy, sfate,
Date (manN. daY Y��