HomeMy WebLinkAboutMortgage_Slinker (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year �/
..,__ . .
FOR DEDUCTION FROM ASSESSED VALUATION
Sfate Form C3709 (R71 / 6-09)
�' ,u. PresaibeE by DeO�nt of Loml GwemmeN FirwY.ro ���
File Mark
wsrRUCnoNS:
Fortn Ned with:
To be �led in person or by mai/ wiN the CountyAUditor or Counry Recorder o! the counry whe�e the property is located.
Filirg Dates: 1) Real PropeRy: Must file dunm� fhe year /or which the deduclion is saughte,�/� V 1 � nu Coun Auditor
2) MobAe / Manufactuied Homes not assessed as Real Properly: Must fJe dunFg Ihet�lvZN i7 months h
6etae March 37 ot each year the deduction is soughL ❑ Cwinty Recordu
See reverse side /or addifional inst/ucfions and qualilcafions.
C'J.
MP�n�jet�'nerorconvafl�pyer �ryctpc8pqspnra�stle)
l%i n a U : vi �v, O i GIBSON COUNTY AUDITOR
Tatin9
�
ro. what is his 1 her ezaG share of
Key number / kgal drsc
a�-��.,_
If narne on remrC is diitemnt Nan Nat ot apPlkant'uMicate 6ebw
Name of rtnrtgagee ar mntrad seDer
ACd2ss o( mortgagce w cantrad seuer (numDei aM stree4 c4�'. state.
Name oi assiy�re w dhu avmer or holder of mortgage
AdEress of asUgnee (number antl street �+ry. sfafe. antl ZIP code)
Oces e�imnt own popMy in any aher
muMy m InCiara?
❑ Yes
20 I 20
If yes. what wunCJ.�
�
n
�
owied wi�
Record m�mher
dtable oxneR
Yes ❑ No
Is Me properry in Question: Mnually As.essed
�+] Rea� aioPeAy. ❑ nmwany wssessea
— ll!'811'CY1�`�...��C�..... --
w�� Ca YCl 1�' �. �. l.�5� � v�nv
......... ❑ NO
)UNTYAUDROR / . l.
20 _ 20
Counry
20 _
Date (nmth. EaY• Y��
F:�;
I I We certry under Ne penalry o( perjury ihat Ihe above arW (oregoing infortnation is We anC cortect ark Nat Me applicant is a resident of InEiana aM
owner I contract buyer of Ne aforemerrti ed property on date application is filed.
Signature (ovp(e; hN name) .1i .y Date (nmfi. daY. YsaA
Person auNOmed Ey
w Cy IC Gi.
�:•R'
Address of authoraed persa� (numberaretl sbee; dry, slate, and LPCOde)
Date (rtanN, Oay, yEa�