HomeMy WebLinkAboutMortgage_Shoultz (6)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Town ' Year
__ _, FOR DEDUCTION FROM ASSESSED VALUATION
State Form 03709 (Ri1 / 6-09)
�,,,, � PresaibeE M�rtmeM of L.ocal Govemmeiri Firence '
File Mark
INSTRUCTIONS: M
e '
b 6e lled in person or by mail wifh the CounryAuditw w Counry Reco(der o/ the counry where the property is lacated.
Fitirg Dates: i) Real Pmperty: Must file during Ne year for which the deduclion is soughL � Co ty Auditor
2) Mo6�7e / Manufactured Homes not assessed as Real Propelly Must file during Me hveNe (12) monNs
6efore March 31 0/ each year the dedudion is sought Recordu
See reversa side Ior edditional instructbns and qualfications. . GIBSON
i1. a/rent Year
rc m� vmat ts his � her erea share
tl rwne m remtd is drttumt Ihan
��'I 1-�0 -D00 •(�41—D1
ge / Caniraa Intlebtedness unpaid as of Mc
' Ma 1, airtent year dai
Name ot rtan9agee or mntrarl aevu ./�
rl
Atldress d �mtga9ee or contract se0rs (nunbv nd sbeet �1: sbta.
Name W essignea m dhn awner w halder of rtarq7age
�gaga / ContraY i'Webtedness unpaiE as d Is Ne aOP��t the sde
� o( aPG �� legal w eWitade ame(?
u❑ �� ❑ No
�����.��,a�,�
is Me property in Question: MnuaOy Assesse0
❑ Real RoPertY ❑ M!uiallY A�d . . .
Pddress ol a55ignee (num0e/ eM Sbeet �: sfffie, E I�/��
Dra«�er NO.::h7'J.......
�CS B�ItlN OMI plOpCfly III BIIY NilGf �. • r• �i251116 QEQUfl1011 �Blf112QUE5� Ofl PfOpHl`/
munry m Ind'ana? ❑ Y¢s ❑ No ' ,• ' � for artent Y��! � Yes ❑ No
20
I1
Card \�o. . � ya���9....... ..
tlreartquntaF. i�� � � ""IOI�W�•
4G�ti'S
20 _ N 20 _ 20 _ 20 _ 2O _
Counry Date (montlr. daY. Y��
penalty of �rjury that the above aM fqfegoing intortnatia� is true and correU aM fhat Ne appliqnt is a resideM of Indiana aM
of the afore entioned prope n dat� a plication is filed.
C _ w � Date (mw+fi. daY. Y��
G!S �
qyy p,z¢ated pwer of Atmmey or by IC 6t.1-12-0.7 =,,,I �� (�W. �Y. Y��
person (numOeraW 5IIee4 �y. slate. and LP mtle) .