HomeMy WebLinkAboutMortgage_Dishon (3);
" STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun 7ownship Year
_ FOR DEDUCTION FROM ASSESSED VALUATION
State Fam d3709 (R10 /77-08)
� w• � Prasaibed bY �PaM�ent af Lmal Governmar� Firunm
INSTRUC710NS: e
To be fifed in persar ar by mad with the CounfyAWifor o1 the county where the poperty is located.
Filim� Dates: iJ Reel Prope�ty: Must !de diaing the yeer lor which fhe Oeduction is sought. II'nI ����
2) Mo6de /MamAaUured Homes nW assessetl as Real Properly: Must fde tluri� tlre fweNe (12) mmUu Db)d� M 3• ch year �
the deCuclion is soughf.
See reverse e lor add'Aional insUVCtion,s and qualifications �
AppGrant( armwxtGN'e�- m sde)
_ D 1 A/ e � � .i/LC� GIBSON COUNTY AUDITOR
• iu - -o� -
naessea v�ue d raa� c ve(y as d �r(p� e � con�raa u
Ma� 1, artreM Y� Maml� i. wrtarp Year
tl ro. what is h'rs / her exatl shara d i�re51T
tl rame on rernd is ELfareM lhan Ihat a( aPG�l indimte 6abw.
[��—�i
d 1mriBapee or
Narne d assignee ar oNer owner a hddm d mwipage
Pddress d a�pnea (nunEOrand sbeoL mY• sAte. and LP mdo)
Dedudian approved'ci the amouM d:
p� � Z� � p_
. a �' Qa �
I as of Malvaae / CWrzd
H amed
aa U Is �he aPd��� Iha sde
legal ar epuitabla o�vneR
i ❑ Yes � No
Is me wwaM � vue5;m: av�wuy nueued
;� Real Pmperty Q MnualyAssessed
Mobile Fiortie (IC 61:
�.L¢.G1-n� ��'#OE—
Dra���cr NO...d.�.�.��.....
Ca7 �� LL � 0. . . I.1 Y �. . . . . . . . . . . � been re^uesled on P�M
20 � 20 � 20 � 20
�b
�/ We ceAify un0et Ihe penafty of perjury that the above and foregoinq informatbn is We and corred and that the appiicant is a iesident af Indana and
owng / mntrarl buyer of ihe aforementbncd property on date applintion is filed.
ss d appf ni (rum6eiand sbeet. cdy. s6fe. and UP mdc)
c �
� L � � ) 1
by dNy ezawled Power N Mortrey or by IC &1.7-12-0.7
��
�Y, Y��)
%