HomeMy WebLinkAboutMortgage_Bower'�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
_ • FOR DEDUCTION FROM ASSESSED VALUATION
- • S�ate Fortn d3709 (R71 / 6-09)
�'` ,µ P2wibed by Departmenl af Laal Garemrtrent Frence ���
File Mark
INSTRUCTIONS:
Form I�ed wi�h:
To be filed in person a by mail wifh the CountyAudilw or Counry Recolder o( the wunty where the property �
Fi/nmg Dates: 1) Real PropeRy: Musf file during fhe yearlor which tha deduc(ion is soughL [� Counry Auditor
2) Mo6ile /Manulactured Homes lat assessed as Real Prnperty: Must h7e dunngl�i�W�re (l��p�ths County Recorder
before MarcA 31 of each year Ne deduction is sought. �
See reverse side /or add'Rional instrucGons and qualfications. C��' M"�—
App5ranl w�e�dcontraGbuyer-seare ' mreversesife)
T � ��°�'�'-°i ��-aD�-v�o ,
v�
nssessed vdWe ar mal aov�v as ot �.tard� 1 a�laa � (� iC as a
MafU 1. ar�etV yPar
If no, whal is ha I lrer exaG share of internsl? If �
If name m remrtf is Sttemnt than Ihat W a7P���• mditate bebw.
Name oi mortg3gee or conVaa 5e9a
Address of mongagce or cantracl sePn (n shee4 �Y. state. arrd ZIP code)
Nartie o
— ��/�
nmres, i
� Dra�r�er \ ...................
����d .io. ..... al� .......
�3; (�73 �
Zb — I 20
I I We certify under Ne �tChalry of
owner I canVact buyer ot the afon
FWI revdent atldress
-b 5 I �. �
Person authof¢etl Ey
strecf,
20 � 20
What
G�BSON
Counry
�-oaS
rwmber
unpaid as d
someo�re oNer than spouse. i�'xate
re
�t i o 0
�nt the sole
�itade ax�reR
Yes ❑ No
Is ihe P�oPertY in Que50on: MmiaM Asse55eE
❑ Real ProPeR1' ❑ A!°!�!�Y P�
vilY? Has �ha deduaim been
� a��t �
2�_ 20_
C.�/ 4l IV 171 �� ( V'
above and foregoing infortnation is We and correcl aM ihat the applinn[ is a
�erty on date application is filed.
aW�or'ved 7e�� (num6er aM street uN• sbte, an0
:��,�
Yes ❑ Nc
zo
I���
rt of Indiana ard
Date (monih. daY, l'aa�
oa�e c,�,rn. ear. r��
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