HomeMy WebLinkAboutMortgage_Lamar""+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
FOR DEDUCTION FROM ASSESSED VALUATION
$mte Fofm 03709 (R71 / fr09)
,' ,.,, Presoibad Dy �epMmeM of Lxal Govemmairi Finante
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INSTRUCTIONS:
For
To 6e filed in person or by mail with the CountyAUditor o� Counry Recorder of the counry where the property is located.
FiHrg Dates: 1) Real Property: Must file dunrg Vre yearlor which the deduction is soughG � C 1
2) Mo6de / Manufactu`ed Homes iwt assessed es Real Property Must fiie dunng fhe hveHe (12J months
belore Malch 37 of each year the deductFon is sought �
See reverse side lor additior�l insVUCfbns and qualr�catrons. ���«
�MP���iowneraroorrtraC ry,aeeres�]tbrnsm sida) T
GIBSON CO �
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Name of rtiortgagea «mntrarl se0er
Address d mortgagce a oontraU sr�er (nuMer end sbaeC
r+ame m assgnee ar ww avmer ar �wver rn rtvtgaga
PdCress W acsi,�nee (num0ar end stree4 �Y. smte. end LP code)
Does ePpliranc own popem� in any othc If yes, what o
counry u� Irtlana?
❑ Yes ❑ No
Dedumon eDPrwed 4� ihe amount aE
20 _ 20 _
I / We certify
owner/conh
Person a�Ma¢eE
-acb.aoa-�
unpaid as af Mortgage / Canvaa
_ ^ tlate of appfiration
Iv
H awned with �rtreo� otlml �
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ae�rd ru
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v
ff.dJnty Aud'rtw
Caunry Recorder
C�
I regai or ePnmox aMnerr
❑ Yes ❑ No
sPause. 4dkate with wiwm
Is C�e P�Pen1' in Guestim: MnuaOy Asttssed
� Real ProPeKY ❑ !��!��Y.� . . _
��,�
Yes ❑ No
20 _ 20 _ 20 _ 20 _ N1 _
co��ry oE� ( l V ��l — �
that e and toregoing infarmaGOn is we and cortea ar�d ihat Ne applicant is a residerrc ot IMiana and
ned p rty on date appiication is filed.
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person (numberaM sbeeL my. sble. entl ZIP mde)