HomeMy WebLinkAboutMortgage_Bemis"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ ; FOR DEDUCTION FROM ASSESSED VALUATION
State FOrtn d3709 (R71 / 6-09)
� l Presaibed by Departrtrenl oi Lool GavemrtreM Fnance
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INSTRUCTIONS:
To 6e filed in person w by mail wi�h the CountyAUditw or Counry Recorder o/ the county where the pioperty is located. F�' �� �9'�
Fifing Dates: 1� Real Property: Must file dunng the year /or which fhe deduction is mtight �j ppunt�tnr
2) Mo6rTe /ManufacNred Homes rat assessed as Real Property: Must Ae dunng the IweNe (12J months
before March 37 o7each year Ne deduclion is sought. � ��d�
See reverse side for additi,Wnal instructions arM qualficafions.
Appfxant (owrier tl buye�- see re m reverse stle)
. /� � . �. . . _ GIBSON COUNTY AUDITOR
y �rn� �h -
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Mazr�h 1. armn year
I
If ro, what is his / hu exafY shara of i
1/ name on �e�wE's E'rtferent Nan iha
Name of rtqngagee w mntract se0er
� - -ODD , d�t� -�i �
Alortqape / Contraa'udebtedness unpaid az W Mwlqage I Contrafl iMeb[etlnass �mpaid as of Is Ne appWan Ne sole
Mamh 1, o��l�mar,,.-�c�� date of app5cation kgal or equilade owneR
�V/ U�� ❑ Yes ❑ No
mdinte GeloM^
wntrad seuu (nuMer and stree; �:
of assu,7nee (nurt�r arM slree4 �1: stafe. an0.>m..,we�. _—_
� a'nPpMant wm pfoperty in any oUc
❑ Yes ❑ No
20 _ � 20 _
someone other Man spousc, indim[e wiM wMrn
\`.
........
- ]�CAVA'CI" 1�•
CaI'(i �q�. ...�•:.`l!.........
– ' $ V) � �� •�
2i�. .�.. , __ I `v—
Is me p�operty in QuesGOn: AnnuaM assessed
❑ Real Properry ❑ Mnualy Assesst,d
Has ih"s Cetlurrim been re7uesteA m pmperty
Ior w�rent Y�n ❑ Yes
❑ No
P���ii�:
I/ We certiy under the penalty of perjury ihat the above a� foregoing intwmaGon is We and mrrecl arW ihat the applinnt is a resident of Indiana and
owner / wntrad buyer of lhe aforemerrtioned pmperty on date appiicatlon is filed.
�,naty�e (own� fiAl nartre) /) - Date (monM. daY. Yme�
state,
Pason authar¢etl by duty esecvied Porer al AvwneY a M IC Ft.1-12�.7
person (num0cr arM sbeef, tlry, state,
Oate (mon(h. QaY. Y��
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