HomeMy WebLinkAboutMortgage_Brown (9)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n' Year
__,_ s FOR DEDUCTION FROM ASSESSED VALUATION �
n State Fortn C3709 (Rt t/ 609)
�,�,. ! Preunbed Ey Depa�menl o( Local GovemmeM Fu�ance ,
File Mark
INSTRUC110NS: O C T �
To be filed in person w by mad with the CountyAuditor or Counry Recorder of fhe wunty whe2 fhe property is located.
Filirg Dates: 1/ Real Pmperty Must file duriry Ne year fo� which fhe deduction is soughL a County Auditor
2) Mo6de / Manufaduied Homes rwt assessed as Real Property.� Must file dunng the tweNe (72) monN�a �y „�
betore March 31 oJ each year Ne deduction is sought �' �OCounty Recorder
See reverse side /oradditronal instructions arW qualificatrons. GIBSON CO.. ..
Ap t wna�warNarlpuyer-see2s(�f�onsmrere
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Remrt1 number
�/II/C
Contrarl "udehtedness unpa70 az of Mortgage / ConSafl uWe6te7Mess unpaid as
�rtent yeg� _ date of appfication
�i M. M'�18� 6�ILS � hEf G%2fi S�IdfB Oi Ill}CfPSI�
1 name on 2mN is tliRerent than ihat W aDP��4 mdirate bebw.
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Name ot irortgagee or mntrarl se0er
1���
�d����� a�� �„��,�,a,��x �: . a,�� _
Name of assignere w othej owner w halder W rtprtgage
Adtlren o1 assigrrea (numCer and aaee; ciq; smfe, and LP oode)
Does epplimnt wm property in any other tt yes, whal munyl
wunty in Intli2na?
❑ Yes ❑ No
COUNTY
20- � �- � p- � 20
spouse, indimte with wMm
numbu
amM
❑ No
IS CIC P�P�Y Ifl CIICSODn: MM12�Y ASSCSSEd
❑ Real Pmperry ❑ ArmuallyASSesSed
Dra�r�cr NO... °?�9......
- ,�� -44�a —
_ Card NO . ............... ... ,
W ���urnon.i"y "r
- � 8a�.� �'��. . � No
\U
20 20 _ 20 _
Caunry
Dale (��h. daY. Y��)
I I We certfy urder the penalty of pe�ury ihat Ne above aM foregoing infortnalion is We and wrtecl aM that Ne applipnt is a resident of IrWiana and
owner! mntracl buyer of �he afo2mentioned property on date appliration is filed.
i�wa�o r: rw �ma) i� _ � n 1 oa� ��m, aar, r��
R
au�twtaetl Oy duh/
ai
Address ot auNo'aed persan (number arW stree; ci(y. state, aM ZIP cUde)
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