HomeMy WebLinkAboutMortgage_Bratton (3)��A STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Couni 7ownship Year
i�! FOR DEDUCTION FROM ASSESSED VALUATION I
S'• State Form a3709 (RN / 6-09)
,,,: � Preunbed by Department of Lofal Govemment Finance
INSTRUCTIONS:
To 6e Red in person or by mail. � Form� nrfed qw� �q
Filing Dates: 7J Real Property: Musf be completed and tlafed in fhe ca/endar yearloi which fhe deduction is sought M�Y Jrh L��L
Mus16e filed with Ne County Auditor or County Recorder o/ (he county where fhe pmperry is located LI ounry Auditor
on or be/ore January 5 o(fhe immediafely succeeding calendar yeac C nty Remrder
2) Mo6ile / Manulacfured Homes irof assessed as Real Propeify Must file with the County Auditor o/ the
counry where fhe property is lowted dudng fhe nvelve (12) montAs 6efore March 37 01 eacA year lhe
deductionissougbt ' GIBSON COUNTY AUDITOR
See reverse side for additional insfrucfions antl qualificafions.
App6wnt (owner w confraa Duyer- see 2sfr&:trons on reverse sMe)
ERIC D BRATTON
Taun9DisViG Keynumber/leqaldescription
MONTGOMERY 26-17-09-200-004.717-021
Assessed vaNa W real pmpeM1y as of Mortgage / ConVact iM�
Marrh 1, curtentyear March 1, curtent year
68,900 Q
If no, what is Ns / her ezac� share of interest?
tl nama on reco�d is diflerent Nan Ua� ot applicant, intlicate bebw:
WILLIAM E DRAKE AND JAMI L. DRAKE
Name ol rtprtgagee w mntracl seller
FIFTH THIRD MORTGAGE
street, ciry, sta:e,
or haltler ot rtartgage
Atldress of asiignee (number aM sfraeG cdy, slate, and ZIP co0e)
any
approveE in I�a artwunt of:
20 � 20 � 20 _
Auai;or
as
date
If mvned
�•�
COUNTY AUDITOR
20
20 _
unpaid as ot Is the aDW�nt Ne sde
legal or aquitaGe awner7
o Yes ❑ No
other Nan spouu. inEicate with wl�wn
Is ihe property in question: Mnualty Assessed
Q Real Property Q MnuallyAssessed
I/ We certify untler the penalty o( perjury that the above and foregoing informalion is W e and cortect and Nat G.,
owner / cqflVad buyer of the aforeme,�tioned property on date application is filed.
Pu0 revCenraEdress o(aDW���Ti�um6er arM sUeeG dty, slafe,
9859 W 575 S OWENSVILLE IN 47665
or bY IC 61.1-12-0.7
Addrass of auiho`¢eE person (number a� sveet. ury. siafe, antl
been requestetl on property
� ❑ Yes ❑ No
_0
, a resident of Indiana and
L..re (manN, tlay, yeah
OS/09Y2012
Oate (monN, day, yeaQ