HomeMy WebLinkAboutMortgage_Mossberger"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS —n ' Year
__ , FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn d3709 (R71 / 6-09)
`,�,� r Pmsoibed Ey DepartmeM ollarsl GovemmeM Finance
wsrRUCnoNS: MAR 1 F�1��`
Form t�ed wiTh:
To 6e Fled in person or 6y mail with the CounlyAuditor or Counry Remrder o! the counry where the property is located.
Filing Dafes: 1) Real Property: Must file durng fhe year fw whicA the deduction is sought '-y� Counry Auditor
2) Mo6de / Manufactured Homes rrot assessed as Real Pmperty.� Must fiie durirrg the hvelve (72J mooth5'� �
befae March 31 o/each yrarthe deduction is mghG Counry Recorder
GIBSON COU
See reversa side lor addifionel instructlons and qualifications.
MP�°n� (owne� aroonoau buyv/ - aee resLi�ons m/everse sde)
TaArg
' Gll —�W
�1:':I
m recortl a Qrtterent Ihan that of aOP�M. uMipte Debwc
Name ot �ee or contraa seller
Addres of rtnrt9agce ar
Oces eppMam own propGty in any othv
counry m Indiana7 n .._ _
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nlmDPf eMStree4 �: sfete, aM ZIP cOCe)
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riry, stefe, aM ZIP code)
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DeCUCtlon approved "e� Itre amount ot
20 20 20
Signenne N CaunN aWitw
20
V
numbg
as af is Ihe aPP�^t tlte 5ok
legal or epuitade oxnell
❑ Yes ❑ No
spouse. irMi�te wAth wlrom
Is Ne pope+ly in Qurstion: MmieAy Asseised
���PenY ❑ !V1nua�yAssessed
\
M��EK�« �
/��q �
ao,o_�
�
�
❑ No
2b_ 20_ ( �20_
Date (nmRi. daY. Y��
I/ We certify under Ne penatty of perjury that tha above and foregoing infortnalion is We and cortec[ a`W ihat the applirant is a resident of IrMiara aM
owner I contraq buyer of the afnremenUoned property on date aPViication is filed.
Sigfanue (awrrefs�p rep�e) Date (monfi, day,1'aaA
. n .- / / n// /1 . ,
^�,TF...r^i
imbe� and sbee4 �Y. ffife, end ZfP oo�
On/ S, i7we^Sv,�le
Poxer of Auorney w by IC 61.1-12-0.7
Pdtlmss of autlra'ved person (numOer aM StrBe; ra}; sfate.
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