HomeMy WebLinkAboutMortgage_Martin (5)^�� STATEMENT OF MORTGAGE OR CO�
___ , FOR DEDUCTION FROM ASSESSED
Stale Fom� d3709 (R71 / 6-09)
1�,,, ° PresaiEed by DepartmeM of Local GovemrtreM Frunce
�sTRUCnoNS: DEC 2 9 2011
Io be filed in person Or by mail wifh fhe CountyAuditof or Counry Recorder o1 the co�nty,Fv,h�em t rty is located.
FiTmg Dates: 1) Real Property: Must file durirg the year /or which the deduction is sougAt.
2) Abbde / Manufactured Homes rat assessed as Real Property Mus! file dunng the ) months
6etore March 31 0! each year the deduction is soughf.
GIBSON COUNTY AUDITOR
See reverse side (or dditional insfruclions and quali�cations.
Apqiram (o�merm p buyer- see re5r�non �m rkverse side) l-�i\ • '
�,�.,,�,a�rs���,�
File Mark
Form Ned NiU:
�unry A�dimr
❑ Counry Recorder
� �,1 �d�;� a-oc�-��-bd8 � � P � 39
Mortgage Contract iMebtedness unpaiA az of Mortgaqa / ContraG inEebtedness unpaiG as W Is ihe applmant Ne sole
Marti� �ye�r O� date of applifation legal w eQuita6le ameR
U ❑ Yes ❑ No
If name on recortl is EHtemnt Nan Nat af app6�an4 �e�te helrnr.
Name of rtrortgagee ar rontrarl se0er
naaress w nnrtgagee «mno-aa
s+reet �: s+ate, aM LP code)
AEdrec ••r'" ' �.
� /Y)A2T�, ����IN&
�= K�2} D�cJd
Detluc4
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VYhat Tarirg D'avict?
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IS NlE pfOpPltY rt1 QuG5LfM1: Mf1112�Y ilS5C55CG
❑ Real ProPertY ❑ Mnualy Assessed
Modle Home (IC 6
Has Ihis deCudion Oeen re9ueste� on C�Y
far curren� reaR
❑ Yes ❑ No
2(1 � 2�
i/ We certify under fhe penalry of perji� that the above � foregoing intortnation is true and correct arW that the applitant is a resideM of IrWiana and
avner / mntracl buyer of the aforementioned property on te application is filed.
I, nre (p� rs MI name) Date (rtoriN, dey, yaah
YI rLR� o�,✓r� 4� t�nn� —
Ilresident o/appl'xant(num0erandstmet. ' .state,a code)
� �-�4 Soc,i4. S-ar,no �t �ir��ice,tGn lN y7(ar10
rson auUror¢e0 Oy EWy executeE d or by IC 61.1-12-0.7 �ate (monlh. day, yea�
Pddress of author¢ed person (numDer a� street. cR}; stafe. antl ZIP tode)