HomeMy WebLinkAboutMortgage_Bates"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
__,_ FOR DEDUCTION FROM ASSESSED VALUATION
• Sfafe Fortn a3709 (R71 / 6-09)
�,,,, � PresaiCed Ey DepartrrieM of Local Govemmenl Fuwce �
FiIQ
wsrRUCnoNS: J U L
b be lled in person a by mail wdh the CountyAuditw w Counry Recwder of the counry where the property is bcated. ���
Filing Dates: 7) Real Proparry: Must tJe tlunrrg fhe yearlor which the Ceduction is sought n� Counry AuCimr
2J Mobde / Menufactured Homes rwt assessed as Real Property Must file during the hvelve (12J month� ,��a.y„
betora Ma/ch 31 0! each yenr the deduction is sought. - LJ (��+^tY Recorder
See reverse side (oraddilional instrucNons and qualifications. GIBSON CO
AGP���ioWNCUCOnjrdUbuyer'seargs(QUlarssmrevelsesiCe) 1� .�
�dng DisVia Key nimber I legal
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A� rahe dmal pfoperty as o( Alortaa
Marrh 1, amJrt yrar Mart3�
Ir ro, �Mat 4 his / trer eraa share ot �nterest7
tl fwne m remfa a 6rte1�t Nan ihat W aDWm��. uMua
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��� �l��l - OO�� - C'�� � o�l r�
/ Contratt WeWednas unpaid as d AAOngage 1 Contraa iMebtedness unpaid as d I
vrrerrt year Eate of ap�ication I
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Pddrea ot or oontract srder (ntm6erend sLeel �Y. smR
Name at assignea w dher owner rn hdder of rt�ortga9e
Aeer�s ot assi�ee (ntimDareiM stree4 �: stete, arN LP code)
moGMY
amount of
E�lfi
Itt owrre0 wiN mmed�B ONer Vtan spouse. Intlic
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pr�",er�0••"' � ..
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COUNTY AUDITOR
axnerl
❑ No
� Ouestion: Mm�aOy AssesseE
1v ❑/,��„aiNas�d
e.�oa�e r�a„e nc 6�.
Has Nit dedur�m Exn re9uested m ptopelty
"...•' for artent yeaR �`I Z, _ 1"1
20 20 _ 20 20 20 _ 20 _ 20
�rema N Camb nuaitw Coumy Date (nnntl�. day, Yea/l
I/ We certfy under the penalry of perjury Mat the above and foregoing infortnalion is true and mrtea arW Mat the applirant is a resident of IrWiana aM
owner I mntract buyer of Ne aforementioned properry on date appiiration is filed. •
��unue ffwr�ers fim r�ame) „ � i Date (nmrh. my, igaA
Addresa W euthor¢ed person
uM sneet �+h, �re. anC LP aotle)
Sf-o�MOn f
W Nmmey w q IC 61.142-07
sbeet cilY. s+ate. enO Z!P mde)
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