HomeMy WebLinkAboutMortgage_Gonzales (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
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� FOR DEDUCTION FROM ASSESSED VALUA�fGTd� g�
� State Fortn 63709 (R11 / 6-09) �. A� �/
�' ,,,, � Presaibed by Departme(n of Lool GwemrtreN Fue�ce
File Mark
WSTRUCTIONS: JU� 9 n 7�
To be filed in person a by mail vnth fhe CounryAUditor or Counry Recorder of the county ere Mep �rty is loCated. Farm fled wiih:
Fil'mg Dates: 1) Real Property: Must file during the }rear for which fhe deducfion is squgp(. �4-- �nty qudimr
2) Mo6de / Manufactured Homes rrot assessed as Real Property Must77e Tluii,�'j�`t�KMelye (12J monfhs
before March 37 of each year the deduction is sought. v r\ ❑ Counry Recorder
SeereversesideforaddjtionplinsVUCGonsandqual�catrons. � GIBSONCOUNTYAUDITOR
1 real pope�tY as of
Y�
Ir ra. whaf a his I her e�mU share ot interest?
If riart�e m remrd is
Name ot mutgagce ar
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RecoN nurnDq I I Fage
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��P�b as of ��B� � Cor�tr� mtlebted�ess unP�d az d
� Eateotapp&atim
se�er (number and stree; city, state. aM ZIP cade)
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Yes L� No
Is Me property in quPStion: Mnualty Assesse0
❑ Rea� Ropertv ❑ nm,ua�y wssesua
Na5 �h's Cetluclim Eeen
for wrtent yeaR
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Date (rtp/Vh. Aay. l'ea�
on ptaperty
❑ No
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I/ We certify under Ne penalry of perjury Ihat the above and foregoing in(ortnalion is We and cortecl arW Nat the applitant is a resident of Indiana aM
owner I contracl yer of ihe aforementioned property on date appficabon is filed.
��unre (owne/a nartrel Date (rnorvh. daY• We�
Dy OWy exeatetl
Pdtlress of authorrzed person (number antl sbeet riy. sfate, and ZIP oode)