HomeMy WebLinkAboutMortgage_Adams (9)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEI�S� Township Year
FOR DEDUCTION FROM ASSESSED VALUATION � r
� �� Stale Fortn C3709 (R11 / 6-09) �
�• l Resvibad 6y Departmerd o( Lacal Gwemmenl F`mnce
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� File Mark
�NSrnucnoNS: OCT 31 ZQ��
b 6e filed in person or by mail with the County Auditor or Counry Recorder o! the counry wheie the p pR is ted. F� �� ��
Filirg Dates: 1) Real Pmperty Must file dufig the year for which the deduction is soughf. �� �� Counry Audilor
2) Mo6de / Manu/actured Homes rrot assessed as Real Property Musf file dunng �he hvelve (12J fh
befo�e March 31 oleach year the deductnon is sought. ��lY R���
GIBSON COUNTY qUDIT
See reverse side for addifional instrucLOns arM qualrf'icafions.
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tt ro. what fs his / her eraG shara af intuest?
ia�s-oa� �R�,
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H ownetl wiM sorrieone
It name on rernd is Giflemit than that of appfKanl, uWirate hebw
Name of mortgagee or mntraU seller �✓
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ACAren ot nnrtgagce m m�trad se0er (num6el ard stree; ctly, sdm, aM ZIP code) _
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Name o/ assi�ee or oihu owner or twlder of matgm>� /'� 1
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AECress ot assk,p�ee (numG O . • • • •
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Dcesappticanto.mproperty �1'"`C,, ���.••'�
munryinlndana? G � .,••
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Ihe amou ,r\
RRRfGI:7
zo _ � 20 � zo � 20 � zo
I/ We certify u�er Ne penalty of pe1QUry tliat ihe
ovmer / contrad buyer ot the afo2mentionad pm
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Pason aullro�¢ed by OWy executetl
Page rvm�Ca
btetlness unpaid az W Is Ne appfrcsnt Ne sde
k�21 W eQuita0le owneR
❑ Yes ❑ NO
spouse.indimtevritl��N�om
Is tM property in puestion: Mnuelty Assessed
� Real PfopeRy � Mnually Assessed
� D�Y
❑ No
zo � zo _
( � I �� .1�1,CJS1f(J I � (� �b�� � � �
foregang infortnation is We and cortect arW ihat the applicant is a resident of Indiana antl
date applicatlon is filetl.
Oate (nmfh. daY. Yea�)
person (numberard sbee4 my. slate, and Z/P oode)
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