HomeMy WebLinkAboutMortgage_Cowling�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES� un 7 nship Year
_ . FOR DEDUCTION FROM ASSESSED VALUATION �`
� State Fwm A3709 (R71 / 609)
S,,,� ° PresaibeE by �ePartmem o1 Loral CovemrtreM Fi`ance �
ile Mark
�STRUCT70NS:
be filed in � qn �� �'
person w by mail with the CounryAUditor or Counry Recorde� of the counry where tAe property is-locat . \
Fdirg Dates: 1J Real Property Must file durirg the year /or which the deduction is soughl. ) t(� unty Auditor
2)Mo6�7e/ManufacturedHOmesnotassessedas�Re�ahPropertyMUStliedunngthetweGIBSON�U�IN7YAU 0
before March 31 of each year the deduction is Counry Recorder
See 2verse side for addilional instiuclions aiM qualificafions.
nppfram (°w".9/imntraa buyer - s� resMCOOns m re�verse uh) _ �, �_
Ass�SSea va¢ie C! 221 poP�`/ �
�1arr�h 1, Ga`PnI year
If ro. what is ha / her e�a slura of intemsi?
IlegaldesCri�
- ov- �
ge/ Contraa'vMe6teEneu unpaitl as U Mortgage / ContraU uWebtetlnes
la t, n�rtent yrar date of application
O
It ovmed wiN sameofre other than spouse.
�t name m �emrd is dirterent Nan Ihat o( appGrant, mCirate bebw.
Name of rrortgagee or mno-arl seller S �
Aild25s Of nqrtgagce or contraq seller (n �Bnd 50Ee; t� , m
Name o( assignee w other owner or hdder of mort�age
AdCress of assgnce (number aM street, tliy, slafe, aM Z/P cade)
Does appticanl axn property in any other If yes. whal counry? VJhal i...
munly in Ind'gna?
�1 ❑ Y�s l NA � _
(wmber � Page rwmbx
as af IS ihe ePP�manl Cre sde
kgal w eWdade mmen
❑ Yes ❑ No
property in QuesUm: MnuaOyAswssed
al ProPertY ❑ lvmually Pssessed
U���'` el fIIO
�''�.a
/1'O
- � ' ` "�iJ
20 I 20 I 20 I 20 I 20 I 20
..�oj� --
�•.�S �� � r�
Dale (mmfi. EaY• Yea�
20
I! We certify under the penalry of perjury that the above and toregoing infortnalion is true and correct and Nat Me appli�ant is a resident of IMiana antl
owner I contrau buyer�the aforemerrtioned pJnperty on date application is filed.
�nawr�'�io n,ers ruv ns )// _ Date (mornh, dar. r�A
revtlent atldress ot appWant (numbe� antl sbee4
auNp¢ed by dWy exewted Pbwer W AttomeY m by IC bl.1-72-0.7
o( auCwrrzed persan (number aM SN.'eL dry. S181e. and ZIP CoAe)
Date (rtronN. daY. Y��