HomeMy WebLinkAboutMortgage_Akers"'� STATEMENT OF MORTGAGE OR CON EBTEDNESS Coun Township � Year
__ .- FOR DEDUCTION FROM ASSESSED V�A 1�1 ��
• State Fortn C3709 (R77 / 6-09) g�
\ 1 P`ewibed by DepaNneN of lncal GovemmeN Firence
� File Mark
��srRUCnoNS: NOV 1 2011
To be filed in person a by maif wifh the CountyAuditw or Counry Recorder of the county where fhe pmperty is bcated.
Filing Dates: 7J Real Pmperty: Must (de dunrg fhe year /or which the deducG6d. `� sol��# _ V
2) Mo6de / Manufactured Homes not assessed as Real PropeRy: Must file tweNe (12) months
before March 37 of each year the deduclion is sougAt.
GIBSON COUNTY AUDITOR
See reverse side !of addiUOnal instnicfions and qualifications.
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tlesaiDlion Recortl number Page number
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11 narne m teoortf a QAferent Uan thai M appticant'u�dirate Dekw.
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monpayee «mnaaa seuer
w contraG seuer (nunGer eM sLee;
Mer ovmer or hdder W mortgage
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unVaid as af I Is Ne aPP�^i ttre sde
legal w epuitade owfM
n Yes ❑ No
sPaue.
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Nas Nis EeduGim Deen repuested m P�W�Y
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Date (monM. aaY, N��l
20
I I We certify under Ne penalry of perjury that the above aM foregoing infwmaUon is true and cortec[ and ihat ihe applipnt is a resident of IrMiana antl
owner I contraG buyer of Ne aforementioned pmperty on date application is filetl.
�reouelowne/s fiArertre) Date (monfi. day, Yea�
Full resiCent aCAress o/ applrtant (n m6er and s7reet, cNy, cvtare, aM 2IP ootle)
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Psson aulhor¢cd Dy Euly executetl Power of /WOmeY w by IC Ft.1-12-0.7
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