HomeMy WebLinkAboutMortgage_Brouser ^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS o n,
_ ; FOR DEDUCTION FROM ASSESSED VALUATION p
Sfate Farm A3709 (R71 / 6-09) l�i
�' � Prescibetl by Oepartmerit of Laal Govemmenl Fi�nce
INSTRUCT(ONS: `� A N
To 6e filed in person w 6y mail witA Ne Counry Auditor or Counry Remrder of the oounty where the property is located.
Filing Dates: 7) Real Pmperty Mus! file d�rrrg the year for which tha deduction is mught.
2J Mo6ife /Manufactured Homes not assessed as Real Property Must fi7e dunng the 1weNe (12) months �
befo2 March 37 o/each year the deducttiron is swght.
GIBSON �
See reverse side !or additional inshuctions and qual'dicafions.
Appfirant(ownerorcontraC6 -searesL'ctionsanre rSe itle)�
�������
Ma�G11, alrPllt yP2f
Ii no. wha[ Ls h's I her eraa share ot interesi?
r/ legal EescnO� Recortl number
�- _ �- aoa .��- o�
Mor�qage / Contraa 4de6tedness unpaid as of Mongage / CanSaC'vdebtedrress �mpaid as d I
Mamh 1. airtent� 9 on Cata o( aGPrrcation I
�U narne m 2mrt1's tlilfeRnt Man Nai ol appOran4 �Cinte beb�r.
mortgagea «
or contraa seuu Inum6er
Name ol �`�nee or othr! ommer or hdder d mMgaga
�1:
AAdmss a/ assignce (number aid atreet, lriy, stefi, aE LP cotle)
p�—"-�m rnm pmperty in a�ry ollxr tt yrs.
� �31Zo ccs Am .�_
Y�
� ��_����
Year
�j,�aunry Auditor
' A���er
If wmed wiM someone Wher tlan spouse, I�imte wM whom
r3.m.y.r_imnc.L�
zo i �
iRaWe wmrY!
Yes ❑ No
Is the property in puestim: Mnuelty Assrssed
❑ Real PmPertY � Mmual�' Assessed
Has this detlu� Eeen
��a�,�
rS�
r• �i
20 _
� ���ry ��I���„�.�:=��-ao
I/ We certi under th enaly of perj�that the aw.� ....] foregoing informalion is We and mrrect arW that the applinnt is a resiGent of Indiana arM
owner I contracf buyer the atoreme ned property on date appliqtion is filed.
»Wra (9�� h� name) _ .. Date (monfh. EaY. Yae�
dent adCress.f�i appfrcant (numDer antl stree4 m76 state, aM ZIP ootle)
��08�5 S�'v�n��Y�F Si-
aulhor'¢td Dy dNy ezetuteC Power o(Attnrney rn by IC G7.1-12-0.7
� of authomed person (number arM sLee; city, state. an0 ZIP cnde)