HomeMy WebLinkAboutMortgage_Patterson"• STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS r ip vear
_. , FOR DEDUCTION FROM ASSESSED VALUATION
Sldfe Fofm 03709 (R77 / fs09)
�' �.,� PresaiEed Gy Departrt�erd a( Lod Go+emmerrt Fuw¢e
F�e Mark
in�srrtucnoNS: AU ��
b 6e filed in person w by mail wiM the County Auditor or Counry Recorder o! fhe wunty whem the poperty is located.
Fifig Dates: 7J Real Properly: Must file durirg the }rear lor which the deduclion is sought ,� � County Autlitor
2) Mo6�7e / Manufadumd Homes rrot assessed as Real Pmperty: Must file dunng fhe tweHe (72) months G�?�,�,�ry �du
6efore March 31 of each year Ne ded�dion is saqht.
Seereversesideloradtlitionalinshuctbnsandoual�cations. GIBSON �
� � I ^'mberl
'fl.�
AssesseE va4ie dreal qopertY as of
Ma'U11. a+�crt yeer
a Ui
If m. whal is h's / tcer eua shara of interesi?
If fwrre m remrd's Qfdervit Nan that of aPpl
IG".'.n'�..��]
�
�D�
, _ �03_ 000. � -o��
mtraa 4de teE�s unpaid as at Martgage I Cantraa uMebteCnesa
en tlate of a0p�cation
� � 0 �
rc ownad wiU, �ne otlrer man spause. 4
se�er (number and streeG �Y• sta�. aM LP code)
Name of assignee w oNri owner or hdd^. -""-
Pnoress rn amgnea lnumcer ena surec
/
Does e�nt am propMy in any oNa
munry in Ind'ana? i-1 .."
umucmn eppro.�ea m me amoun[ or.
� �_
sg�awre mc«�y,wart��
� 1/ We certify unde e penatty of p
owner I contract buyer of Ne aforer
� Sig (ornefsMreme)
/ . �
Fu0 2sitlent eEtlmss of a �nl (number
k �r, � ��. � _,+� �
/
o_ 36oL
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MCrm af eWwr'ved 7�^ (number aM sbeet �: sfufe. eM LP mde)
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�
R¢mN numEer P e numDti
O/ O � (p0 �
unpaitl av d Is Me app�rmn tlx sda
legal a emritade oMmlt
❑ Yes ❑ No
whan
�6an:Mfwwa9yA.sessed
❑'N?tual�YPsu�ed . . _
Sm Eeen rc9uesteE m P�Y
n ❑ Yes ❑ Ni
_ p
-„�. �Y ��
n is a resideM of Indiana and
nmth, daY. YgaA
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