HomeMy WebLinkAboutMortgage_Peil"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o"n o ns ip Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION g
• State Fwm C3709 (R71 / 6-09)
, 1 Presaibed Ey Depanmem af Laol Govemment F�nce
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INS7RUC770NS:
Fwm fDed with:
To 6e filed in person w by maii wifh the Counfy AWitor or Counry RetoNer o/ Ne county wAe2 Ihe property is locafed,�j
Fifim� Dafes: 1) Real Property Musf �le dunrg the year /or which the deduction is soughf. /� '� a iQ � Counry Auditor
2) Mo6de / Manufactured Homes not assessed as Real Property: Must file dunng [he tweNe (72) months
6efaeMaich37o/eachyearNedeductionissayht. GIBSONCOU T " p��'Re��
See reverse side lor addGanal instructions and aUaFCxations.
�u.1/1.1i � nan0er l��(J� V� O J S U' -�O . S�-p : 4 RecoN number Page n J/
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Assessed � of real piopeM1y as d Mot(pa Be I Cantract inEebteOness unpaid az d Mwtgage / Contrad inEebtedness unpak as ot Is Ne aPP���t Me sde
Na�rh 1. a�rbn year Mard� 1. nt Oate o! aPP��^ kg31 or epuilable ovme(?
I � O � ❑ Yes ❑ No
It no, what a his / her esact share of inte�est? tt ownad with someone dher tlwn spouse, ind�te wBh whom
Ii nart�e m �emtl i5 QfRr�ent tAan Ihat W aGP�^L'vWicate bebv! Is Ihe WoPenY in Vuestim: MnuaM AssesSeE
❑ rtea� Roaenv ❑ a,��ny w�sessed
na� o� �ae� or m,v�n
�9� �
or aNr owro-'
fny. slafe. aM LP code)
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DCa���eC ��' • • �"n.,
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I/ We certify under Itie p
owner / mntract buyer of
Si6faDUe (o C/s MI ^e^re)
F II resident adCress of appfrcanl
S� Ioc��7 E�
Pason autlia�d by dWy ezecu:
lddt�s of aNhm¢ed 7e� (m
of
NTat Taring Dabic[?
COUNTYAUDROR
20 � 20 � 20
Mas Nis deduQian Deen reduestetl on pmprny
for W�rent yea/.� �_. �,
20 � 20
I�ou�ry�.ey� I Date (rtiont/lla�,ya�� V V9
llr!
the ahove and foregoing intortnalion is true and cortect arW Nat ihe applit�ant is a resident of Indiana aM
property an date applicalion is filed.
imDer ane streeC city, state, a
_ee�=�l �
Power of Aupney or by IC 61.1-12-0.7
he� aM straet, ciry, slale. and LP code)
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