HomeMy WebLinkAboutMortgage_Brines^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm A3709 (R71 / fi-09)
S I P�esaibeE Oy Deparimerk of LocW Govemmerit Firiance
�VS7RUCTIONS: e a
fo be filed in person or by mai/ wrth the CounryAUtlitor or Counry Recorder o/ the counry where fhe property is located., r� F p ��'��
Filirg Dafes: i) Real Pmperty: Musf file during the year /or wl�ich Ne deducfion is sought U C O��unry Auditor
2J Mo6ile / Manufactuied Homes not assessed as Real Property Must file dunng the M1velve (72) months
befora March 31 oleach year the deduction is sought. C� Counry Recorder
See reversa side /or additiona/ inshuUions and qual�cafions. V
nppricar��wneraconoaabuyer-seeresni�,6o�smreverseside) n . � GIBSON COUNTY AUDITOR
Ta - D'atrict
t
,��d�,���
Mamh 1. aareM ypar
no. wna� a na � ner exad share o� interesn
r/ Iegal GesmplioR Record numbu Page number
� - a-o� -aa3 _000. a-v6_o �x � -,
t.br�qage / Contraa iMe6tederess unpaid as of Mongage I Con7aa mtlehtetlness impaiE as of Is Ne ap�nt tlx sale
Mard� 7. anrenl year date o( app(rcation legal w epuitahle rnmeR
Sb o o J ❑ r� ❑ No
H awned with wmeane other tlun soouse. iMimte v,ith xirom
If name m recoid'S Eifterent Nan Nat af app6�an4 �dlnte Geb`�'.
Name of nrortgagee or contract seller n
Mdress of mortqaqee or contract se0er (nuni6er and sfree; cM• ��e.
Name at assi�ea w dher ovmer or hdder of rtartgage
NS �
Dces applip(4 ovm pfoperty in any i
counry in IMaria?
❑ Yes
Deduction approveE in t�e amount of:
20 _
Signawre N Camry Autlitor
'Y
I/ We certify under Ne
owner / wntraq buyer
� Si9na �e (oKnerS fi�u rertie
� WI resi0ent address d a
tlry, sfafe.
No
20 � 20
bf P���ry
faeme'roc
property in quesGOn: MnuaDy Asscsud
eal PruPertY ❑ Armualy PasesSed
Mob�le Hane fIC 6
V'. W�U'—
�- � - —_ — _ _ '. ' —
I? What7a�drgD'af+ict; a��� ���C(y�
SU� 3
GOUNTY
"— 1"I I 1
20 _ � 20
Caunry
above aM (oregoing infortnation is We and correct ard that the applinni is a resideM o( IMiana aM
�erty on date application is filed.
Date (rrnrYh, day, ysa�
slate.
Date (monN. daY. Ysa�
Pddress of auNprzed person (number amJ sneet �+N. stale, and ZIP code)