HomeMy WebLinkAboutMortgage_Adler (2)"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS cour
_ = FOR DEDUCTION FROM ASSESSED VALUATION
: " ' " Sta[a Fwm G3709 (R11 / 649) � ,
�' ,•,. � PreSmbeE Oy Departmenl of Lccal Govemment Finante
INSTRUCTIONSr � -
To be filed in person w by mail wifh the CountyAUdifor or Counry Recnrder o7 the oounry whe2 the property is locafed
Filing Dafes: 1 J Real Property: Must file dunng fhe }rear lor which the deduction is mught.
2) Mobde / Manutaciured Homes nof assessed as Real Property: Musf fiie dunng [he hveNe (12) monfh;
6efo2 March 31 of each year the deduction is srought.
See reverse side for addifional instnictions and qualifications.
Applinn�,{pwnerorpmtradbN'e�-/ / II/1_ .mrevl� sitle) D //n \i✓1 /( liA ,._ _... �
/ / /L
1' S:o�
If ro. what a Fvs / tier exaC �ara o( interest?
If name on �etotd'p Aiiferent Nan that ol app�tant, hiEicale 6elow
Mark
�C�4 i�CUU7itor
Caunry Recorder
GIBSON COUNTY
J rn - vv —�/ pc r- vv i U v
aG iMebteCnass unpaid as of Mortgage I Contraa uWe6tedness unpald as o! Is Ihe aOW�� be sole
year tlate of appGp � legal w equitaWe ameR
� ❑ Yes ❑ ND
H ovmeE wiN sommrie other Ihan spouu. iM"�te with wMm
15 Me property in Quesnon: Mnua�y Assessetl
❑ Real ProPertY ❑ %���H ��
Name of rnortgagee or conuar15e0er �/�
Address W mortgagee or mntrad seAer (n and sOxe4 crty. stafi, aM LP cade)
Name of assignee w othei awner or halder of mortgage . -
Pdtlress o1 assignee (numDer antl street f4y. sbte, and ZIP code) -
Dra�r•cr 10...,�:U��......
Dces epplimnt o.m property in eny oNer K yes, whal munt�? W�at Tapng C '
munry in Intliana? U
❑ Yes ❑ No C�1�Cj �i�. ....1�. �........
COUNTYAUDROR - $ C� C� , a�� (rU
Deduction approveE in ihe amount of: U �
20 20 20 20 _ 20 20 _ 20
Sig�alure W Coun�Y AW itw Caunb DaLL (month. daY Y��
I/ We cert'rfy under ihe penalry of perjury that the above and (oregoing infortnalion is We and cortecc arM that che applinnt is a resident o( IrWiana and
owner I contract buyer of the aforemerttioned property on date applicabon is filed.
Sig��owraRs !W name) ./1 Data (month, eaY• Y��
� r �n. ,, n n
Person auNO(aeE Ey Guty ezecutetl
Adtlress of author'ved person (num
sfreet, rity, state, and Z/P code)
�
� Attamey m Dy IC 61.142-0]
sbeet. c'rry. stale. arM ZIP cotle)
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