HomeMy WebLinkAboutMortgage_Goodman (2)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou ns ' ar
,._ FOR DEDUCTION FROM ASSESSED VALUATION
State Form d3709 (R70 /17-08)
� � Presaihed by DeP�Mienl d Loral GovernmaN Finanm
wsrnucnoNS: M� ^'�^i 2009
To 6e filed in persan or 6y maB wifh the CouNyAWitor d fhe oounty wheie the prvperty is kcated.
tilirg Dates: i) Real Pioperty: Musf @e dunng the year (or whicA the deduction is sought.
2) Mobde/Marwlacturetl Homes rrot essessedes Real Property: Must file duri�ng tlie 1weNe (12) monUu befae�3f �6�ifi� r
the deQuction is soughL
Seeieversesidetoradditionalinstn.aionsaledqualifications GIBSON COUNTY AUOITOF
'��"�°"��� n �'f o =:"� a�,.�'°��o �_� ..�.,. _ _„ �
Pssessed
Marth 7. �
H ro, what is his / ha e�d shara d ittleresYl
�-�o�,-�a.s�-r- oi
irca,�aaineeaednessunpafaas: xl
wrteM year dafe
ni.-�oo
n nan» a, rec«a is earetam cna� uu� a aoo�. �,aipm cerow
Na�re d moM1gagae ar m�acl seDer .�
AdErass d moryaagee v mrtraU ae0er (nunber and sliooL �: sfafe, and ZfP cade)
Name d assigrrea or a}her wmer a hdder d mMBa6e
Address o( assignae (miimd.r antl sbeeG �Y• #am, ana
Does appti�ant awn yoperty in a�ry alher
murity in IMia�?
❑ Yes ❑ No
Deduaion app�oved'v� �he amoum of:
�
Signatura of CouNyAuditor
20 _
I/ We certiy under the penal
owrier / contrac3 buyer M Me
,F ���z�:
legal a eQUitable awneR
❑ Yes ❑ No
If awned rrith someorre other Ihan sP��.'u�drata wBh r}m�
}b -m.�e o�oem � Westia,: nmu,aM asse:sea
fQK� P���Y 0 MnuallyASSe55ed
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4�'/ � \� �
r�,goa �IO��� ��LE.rSuQ L do
fOR ���0���` _
�y
20 I 20 I 20
Ne above aM fwegoirg n(om�ation is true anA cmrec] and that Ihe appGpnt is a resident of Indiana and
properly on date applkation is filed.
. . _ Date (rnonlh. daY. Year)
oate l�mun. aar. t�l
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