HomeMy WebLinkAboutMortgage_Odam"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__,_ : FOR DEDUCTION FROM ASSESSED VALUATION
• Siate Fortn d3709 (R17 / 6-09)
�,.r � PrPSaibed Oy OeO��M of Loml Government Frence
File Mark
INSTRUCTIONS: D
To be (led in person w 6y mail with the CountyAuditor or Counry Recolde� of Ne counry wheie the propeity is located.
Fii'mg Dafes: 1) Real Property: Must file during the yaar (or which Ne deducUon is sought. � Counry Auditor
2) Mobile / Manufadu�ed Homes rrot assessed as Real Property: Musf fiie dunng the twelve (72) months
be(ore March 31 0! each year the deduction is srought. 6� Remrder
SeereversasideforadditionalinswctiansarMqualifications. GIBSON COUNTY AUDITOR
I AooGOUCA�wm a oontraCGuyer - see restnteons m reverse idai � /
Asessed v
Marth 7, a
IIt m. what
If riame m
�
�
Key number / ka9'desca
��.� � r17 _
Name a� mort�a9ee or convact sener /�
GS "
Add2a d morVja9ee n contrac� sWer (r
Nama ot assi�nee w oNU awner or hdde
PLdress oi assgnce (number aM sneet �
�oes a�i�nt awn pmperty in any oNer
munry in �n0iara? ❑ Ye5 �
20
I I We
owner
apprm� m u,e ama,m ot
20
ofCOUnryAUd r
ce under Ihe pen Iry of pe
I�contracl buyer of ihe atorem
Eebw.
T.
— DO
unpaiE az
�
7 77-0 � D /Y/
IIf ovmed wiN someone
_ . e
'. indebtedrress �mpaiC as d Is Ne appluant the sde
legal or epuitade ame(.�
❑ Yes ❑ No
Ihan spouse. ind'rcate wflh vArom
Is Me pmpercy in 0���: A^nua�y Assessed
�� �aem ❑ (v,�ua�!ra� . . .
C���, ��-� E
-�/�i�y �
�q. ���
_ ' ' "YY����NII �i IIICQ.
Full resAfent adereis d a t Lumber ane streeG riry, srate, aM Zla m
S 7�o uS 5� CJ, �d /�// �
Person auNOraed Oy Outy executed Pawer o Attorney or by IC 6.1-12-0.7
Pddress of autha'¢EO person (numDer aM sbee4 �: ��. and LP mtle)
�P�Y
❑ No
. . __... _ _ ....,..�� �..,i nw�ana and
Date (monfh. daY.y� r)
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c� '�jlo G I
�ate (rtronN, daY. Y��