HomeMy WebLinkAboutMortgage_Reid"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ s FOR DEDUCTION FROM ASSESSED VALUATiON �
• Stafe Fortn C3709 (R17 16-09)
�,.�. Presvibed 7y Departrt�arn oi Lafsl Govemmerd Fuante
F' e
INSTRUCTIONS:
Form fded wNh:
b be fifed in person a by mail with the CounryAUditor or Counry Recorder o/ Ne county where the pioperty is bcated. 'n'n
Fil'mg Dates: 1) Real Pmperty: Must file dunrg the year for which the deduction is soughG A U 1��Mty q�ditnr
2) Mobde / Manufactuled Homes nof assessed as Real Property Must file dunng Me IweNe (12) months
before Maich 37 0l each year Me deduction is mught. ❑ Cou^tY Remrder
See 2verse side (or additiqnal instructions end qualfica[bns. ~ 6-� .
�OYfP'OfODn°ar76i�`�� °"`���8� � GIBSON COUNTY AUDITOR
� T ' D' � � Key �wm6er / legal desaiptbn Remrtl numbc Page rwrt�u
a(o -�9-l9 - �oY -oo/. �8i- � a� oio �
Asetsed vaWe d real qoperty as d Mortpa ga / Contraa iMebtedness unpeid as of Mortgape I Cantrect'vMebtedness unpaiE as d Is Me epplirant Ne sole
MaU 1. arteru Y� Marrh 1. armnt yenr aate ot ePWcaiian � a¢OW� �'
I O [7Q D Yes ❑ No
tt ro, what b ttis / her eraft sl�are of interest? If wmed with someme atlrer than spouse.'u�di�ate wMh whom
tl name on �emN e Etllumt Nan that of appUpnt, Mdicate Eelow. K tM property in QuesGm: Mnua�yAS5e55e0
❑ Real afoaeKV ❑ /+�+�N�
Mohle Fiortie QC G7.1-i
Name of mortgagee w mntraU seller '
ACdress d mom)a9ee ar mntred seUer (nunbe� and saeet �y, atate. aM LP code)
Name d�ee a dher ovmtt or hdder of rtnrtgage
AAEress of assi9nee (numbar end saee4 �Y• �, aM LP code) � � � p
7
Dces aPplirant am pfoperty in any oNC I( yes. wfiat countyt lM�at Tari�g Distrirl? Has tlre �m Oeen reQUested m pmpeny
munry m ind'ana? ❑ Yes ❑ No ' �•v mrent Y?aR . j� Ye5 ❑ No
D��ativer 1\'0... a2 /
cauNrr nuorroa ' �• •Q •
DeducGrn aPWO� in the amount oF. ) ••••••
C.11'(� l�i �. . . . . . c3 (o � C�%
- ..............
20 _ 20 20 20 _ e .
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� I/ We certity unde e penatty of perjury the above aM foregoing intwmatlon is We and mrrecl and that Na appGrant is a residerrt of Indiana and
ovmer I wntrad buyer of the aforemerrtioned property on date aDP��tion is 51ed.
� s�a is mu rame) Daate (mw+m, daY• YmaA
up rnt aGtlmss d appfimn (nu r an0 sbeet. tlry. stale. and LP code)
E o S r-� l� -� �
Pe�son authwaeC by Outy executed Powei af Y a bY IC 6.1-12-0.7 Date (ma+R+. Ea�: }ea�
Pddress of auNOr'rsEd person (numbereid sbee; dry, state, arM ZIP mtle) .