HomeMy WebLinkAboutMortgage_Johnson (5)^�� STATEMENT OF MORTGAGE OR
:.,-..
FOR DEDUCTION FROM ASSES:
� S�ate Fortn G3709 (R71 / 6-09)
♦ d Presaibe0 by DePartmenl o( Local Govemmeirt Flrenc
(/������sTRUCnoNS: FEB 7 2012
pro be filed in person w by mad wifh the CounryAUditor or Counry Recorder of Ne oo�nty� , perty is located-
Fd'mg Dates: 1 J Real Property: Must file durirg Ne year Por which the deductlon is sough�l�
2/ Mo6de / Manufactured Homes rrot assessed as Real Property: Must fi/e dunng M (72) montAs
6efore March 31 ofeach yearthe deduction is sought. GIBSON COUNTY AUDITOR
See reverse side 70l add'rfio�l instrucfions arM qualifrcations.
AppGram (owner « r �see resMUbns m rer�rse _ /� (� .
nssesscd vadre � real property as
Mamh 1. aarem year
Ii m, what Is his ! Irer e�] share of interest?
If name on recad is dirterent than that ot aPpficanf,
mort9agce n contract
w oNe� owne� or
state.
P4tlress of x«^ee (number aM spee4 �y, slate, and ZIP cotle)
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-OOI • �IG�'floLS
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File Mark
Fwm f�ed wittc
unry Audit�r
❑ Counry Recorder
Remrd�numCei Page���
b
unpaiC as of Is I�e ap�dmant Me sde
kg31 a equiiade avmeR
❑ Yes ❑ No
Is Me property in vueSDOn: Mnually Asse55e0
❑ Real Property ❑ MnualyPssessed
M1bbile Fiorne (IC 61.
I Oces applicant own poperty in any other I If yns. what munry? I VJhat Taung Dis[rin? I Has Iha detlu�fion been reduested on pmprlty I
counry in Ind'ena? ❑ No ���nt y�n ❑ No
❑ Yes ❑ Yes