HomeMy WebLinkAboutMortgage_Coleman^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ _ FOR DEDUCTION FROM ASSESSED VA�T{p� � T
� � Stata Fo�m C3709 (R71 / 6-09) � ��
,,�,� � Presrnbed by DepartmeM ot Laol Govemment Frence
�— File Mark
�vsrRUCnoNS: �u� ' n��
To be filed in person w 6y mail wiN the CountyAWifor or Counfy Recader o/ th r�'AI roperty is located. F� �� ��
Fd'mg Dates: 1) Real Propeily: Must fJe-during fhe year (or which the deduction is se yht � Cou�ty p,�dit��
2) Mo6Ae / Manu/actured Homes rrot assessed as Real Propelly A�sl-�@�S�i�Ne (12) months ❑
before March 31 of each year the deduction is swght Counry Recorder
Seareverseside%raddd"analinshuctionsarMqualrficafions. GIBSON COUNTY AUDITOR
1' J1�
ro.
rwmCu
If name m remrd's Nfterent ihan Mat W aDP���. �inte 6ebvr
rlame m rrongasee a mnvaa seva
Addtess of rtnrcga9ee w contrad
zo
SiBnaWre
ovmer w
numbu
(..of� –YJ � J
aQ "cWebted�s unpaid as W Mortgaqe / Conba�2 cbebtedness unpaitl as of Is Ihe appfxant the sde
� 2(} �1 �i
d2IE O/ BG��� �j21 Of EQUlida¢ ONM/1
I�J7 V �V ❑ Yes ❑ No
H owne0 wiM someare ahe� ihan sG��. iMirate with whom
Is ttie p�opertY in OuPStion: MnuaM /�esud
❑ Real PmPeM Q MnualiyASSessed
. Moble Home QC 61.1-i
�
. . aM ZIP code)
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�-� �0 �.� ........
t` Q. a Ta�d�g Davic
Dra"�Y �. .
3Sn l.o... •� • •
CaYdrp. � •i39�app. / oR
5�3�."�°' _ ► Zo_ �
under Ne penalry ot perjury that the ahove
ad buyer of the�taementioned property o
authoraed Oy Ouh/
�m6eiandShBBf. Ci[y, stare.
� s� 6s
Power o(Httmiey or by IC 1
person (numDer a�M sveet ciry. stale, antl ZIP coUe)
Caunry
Has this AetluUim Oeen requested m GmpertY
�a«� �
❑ Yes
� � �
miation is We and correct and Nat ihe applinnt is a resident of Indiana aM
is filed.
Date (nmfi. daY. Yea�
r,�
�ace �rtpnfh. Eay Y�/)