HomeMy WebLinkAboutMortgage_Hall (7)""+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coum
_ FOR DEDUCTION FROM ASSESSED VALUATION
State FOrtn G3709 (R71 / 6-09)
�' w. Presvibed OY ��rt o1 LoCal Govemnient F�
INS7RUCT70NS:
b be filed in person a 6y mail with (he CounryAuditor or Counry Recorder o/ the county where the poperty is located.
Fitirg Dates: 7) Real Property: Must fde dumg the year fir which Ihe deduclion is soughf.
2J Mobile / Manufactumd Homes rwt assessed as Real PropeRy: Must file dunng fhe tweHe (12) months
be(ore MarCh 31 of each year the deduction is sought.
See reverse side lor addi6onal instructions and qualifications.
nppG�ant (owrer or byyer- see 2stricnw�s m r�ersa sida) __ ,,,,
�a ' Dis ' Key n mber / le Eesmp� =
�
Marrh t. �v�eN Y� �Y es of Mortaage! Con �
Marrh
i M. Wh2� IS hR ( MllYdf2 Sh818 Of V11CR51?
If rwrie m remd is 61fe2nl than tlfat of app0�an; uMifate 6elow.
Name ot m�r�agee u contraU uqer /`J
[.
Add2ss of mortgagce or contraG seAer (numbra and streeL �Y. sate.
Name ot ass'ry�ee a dhu owner a hdder W rnor4}aye
Add�ess of assignea (numeer aid streeL �'. strro '^-"•' ..
�oes eppumnt wm prope�ty in eny omer
mUnry in InCara?
❑ Yes ❑ N�
D� F�5^2��
❑ Caunty Recorder
M GIBSON COUNTY AUDITOR
. � _ D� Remrdnumbc Pagenumbc
{ O
unpai0 as of Mwigage / ContraC @WeMeCness �mPaid as d Is Me aC�+t the sale
aate ot appLratm legal a equiratle ovmeR
❑ Yes ❑ No
rc awnea wiM someme dher than spouse. IM'xate wi�h whan
Is ihe praperty in QueLOOn: Mnua%Assessed
❑ Real Piopertv ❑ Mnuallr Asse�d -
Dra`vcr \O..�IO.........
5�13
c���� �o . .....................
� c�5,o�.�
Has ih's dedu� been reQUrsteE m pmpaty
for aurent Y�r r'1 .. I"1
zo zo �� zo _ zo _ zo _ so _
Sig�aMe oi Camb AuO�rtw Counry Date (rtmtti. daY. Y��
I/ We certify under ihe penaly of perjury Mat the above arW foregoing infortnatlon is We and cortect aM fhat Ne applirant is a residerrt of IMiana and
owner 1 mntrad buyer ot the ataemerrtioned property on date application is 51ed.
Sigra°'"e "L/s hAl "�rr'e) ii ...,. ,. � n,. 1 1 n A oace (morifi. dar, rea�
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