HomeMy WebLinkAboutMortgage_Dodson"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ = FOR DEDUCTION FROM ASSESSED VALUATION ,
� State Fwm d3709 (R71 / 6-09) .
�' 1 Presm3ed Ey DeparVnent of Lxal Government Finaixe �
File Mark
INSTRUCTIONS: N O V �F
To 6e filed in person w by mail with the CountyAuditor or Counry Recorder oI the couniy where the property is located. �
FiNng Dates: 1) Real Properfy: Must fife tlurirg the }rear for which the deduction is sought County Auditw
2) Mobde / Manufadured Homes rrot assessed as Real Properly Must fiie dunng the Avefve (12J rtwnNr,/�j �}-�i
6efore March 31 o/each yEar the deduction is soughL (� •� ^�'LJ"`��nty Recordu
C/
See reverse side foraddifional instiuctions and qualificatuns. GIRSON COUNTY A I
Appf�t(ownerwconvadbuyer-see2stric�nsm2verseside) .n . . )
naessca vMie m rnal p�p2rty
MetCh 1, arrenl yn.ar
If ro. what a Ns I hef e�1 share OI interest?
____..
- -ooD. y �-v �� a�oo 9 4�90 �
Cantract inde6tedness unpaid as of Mongage / Cantraa mdebteEness unpaid as d Is �he apd�l Ne sok
irtent yeer date of applkation legal a equNade amM
� ( 9 � ❑ Yes ❑ No
If owned vriM someone other ihan spouse. IM�icate wBh whom
If reme m remC is OiRerent Nan Mat W aDpOpnt, uWicate bebrc
Name ot mort9agea w mnvact seUer �/�
Pddress W rtortgagrx ar mntracl seder (numba� stree4 �+N. state.
Name of assignee w oth� owner or holder of mortgage
AECress of assignce (numDer and shee4 �N: sm+e, aM ZIP ooda)
Ooes appfuant ovm pmperty in any oNer If yes, what co
munry in I(d'ana?
❑ Yes ❑ No
Dr�uction apprwed in Ihe amoum ot
ZO � 20 � 20 � 20 � 20
prJty m O�m^: MnuaDy t�ssessed
�P�Y ❑%M���Y�
DI':1\1'G' �'�... �!:':�'.1•......
Cai•d NO. ...7� ��.........
� �11���7. �
20_ � 20_
SignaGve o� tn� J �� I Caunry I Date (mmtA. tlay. Yra�
I/ We certify u r the penalty of rjury Nat the above antl (oregoing infortnatlon is We and cortect arW Ihat the appfxant is a resident of IrWiana and
owner / mntrad buyer of ihe aforementioned property on date appliption is filed.
Sioa65?�c (owne/s /utl aartra . /� � (�. dsY. Y��
ot
� �� �,.
person (number an0 shee; rif}: sfata, and LP mde)
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