HomeMy WebLinkAboutMortgage_Barrett (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ ; FOR DEDUCTION FROM ASSESSED VALUAT� g g �
State Form C3709 (R11 / 6-09) � 8
, � Presttibed by Departmenl al Laml Govemmenl Fi�nce JL ��
File Mark
wsrRUCnoNS:
Fortn (li ed with:
To be filed in person or by mail wi(h the CountyAudiror or Counry Recorder of the county �YreGthe P���y is located.
FiNrg Da[es: 7) Real Pmperty: Must file dunng fhe year for which fhe tletlucfion is soug6[^ ,n --rr11----'' �',ounty Auditnr
2) Mo6Ae / Manufactured Homes nof assessed as Real Prt�perty: Must fife ddFl�igt�rew� /72) months
befora March 37 of each year the deduction is sougM. v v ❑ County Recorder
Seereversesideforadditionalinst/uctbnsarMqualfirations. G�BSONCOUNTYAUDI70
Appfecant (owre� mmntrdp buyer restrirlms m rev�rs�idel �i i
,...�...� -�-� a G- I 9- l�-3 03 - oor�_ �! oa� �� „�� �
1 d rnal popsty as d MoRpayG(�o nbacc'ude6teEne55 unpaid as of Morigage / Cmtrar� indeMedness unpaid as o( Is Ihe appli�sn[ Ne
a+�eN yrar Marr3�C `j,�r{eyUmar� ^ Oate of eppGration legal O de Q
`! U l..(� J Yes No
tl rq, whai is his l lrer P.�C 5hare of intemsl?
If name a� mmp is diRbm[ Nan Nat d appOCant, m0irate bebw:
Narre af mmgagee or� .
Addrea N�' ^
�IV
......
Cl �O lJ
�; �.. � a �3 .
�J.o• ��•�' ••.
a �v1
C:�� n� l I � J No
'�`Q�d-
� �
Deduuion apprmed in ihe amount of.
someone ott�er than spouse, i�inte v.ith
te. and LP aode)
�� yes, what munryl VJhat Taring Disvid?
COUNTYAUDROR
20 I 20 _ 29 20 I 20
itu °t ,a' Y k� _ �. � _ �nb . /
I/ We certify under ihe penalty of perjWy that the ahove r� foregoing intwmalion is We and
owner I mntracl buyer ot the aforementloned property on date applicatlon is filed.
signature(owne/stu0rwme) . ./1 � i
revtlent
state,
Address of auUqrrzetl person (numbe�a�M sLeet, dry. state, an0 LP mtle)
FoRf
I5 ihe D�PenY in 9uesfion: MnusAy Asu55e0
❑ Real ProPeKY ❑ ��Y�
Nas �his dedudiat Deen reQUested m P�WttiY
for artent yeaR
❑ Yes ❑ No
_ 20 20 _
Date (monN,
�//
and that Ne applinnt is a resident of IrMiana aM
Date (month, day, yaa�
�t� s,� y��y8
o� t,�. �r r�eo