HomeMy WebLinkAboutMortgage_Hayden^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ s FOR DEDUCTION FROM ASSESSED VALUATION �
State Fortn C3709IR71 / 6-09) '
�,�,� � Prestribed by OeP��nl of Lxal Govamrtrent Fuwnce
File Mark
INSTRUCTIONS: �R �f
To 6e filed in person w by mail with fhe CountyAUditor or Counry Recorder o! the counry where the piope t€d LO t F� ��:
Filhg Dates: 1 J Real Property: Must file during the }rear for which the deduction is soughL o-�unry Auditnr
2) Afo6de / ManufaGured Hanes not assessed as Real Property Must fiie during fhe rtvelv�f7,E7
6efae Maich 37 of eacA year Ne deduceun is sought. ❑ �^h R��
^ Seeraversesideforadditionalinsvuctbnsandqualifications. GIBSONCOUNTYAU
p{ (owrerbr CbuY�r- mie�ersesde) ('. � (�
' � b �.i�v.n.
eraa shara or interest?
on RmrC a 6Refan M3n Nai ot aCP��i. uWicate bebw
Name o( nnrtpagra ar mntraa se9er
ndaran a � or �o-aa
�� a
naa� ,�._ — m
R� q�'
��� � �pc,NEl- (�
0
�0�� w���
I/We
�
'JP catle)
6. wh2l C011iflyi
COU
N I ZO
penalry of {�rjury Nat Ne abor
�( the aforemerromed property
rnJ!
�
c� i
Whal Ta�g District7
�
�
( I P�8
���
Yes ❑ No
IS IM P�V�Y 111 Q1161M: M11110q' ASS2SSCC
❑ Real Pmpeity ❑ MnuallyAssessed
i�2b I�16 dL'dUmOf1 �I,'CIl lIX�UGSiG4 dl plOp2flY
tm wirent Y�R r-i __ r-� .
p_ � �-
foregoing intwmatlon is we and correct arM Nat ihe applirant is a resident of I�iana and
te applicatlon is filed.
Date (nmtl�. dsY• Y�a�)
persan (numberantl street dry. sfale. and ZIP ootle)
Date �rtonN. EaY• 1'ee�
y