HomeMy WebLinkAboutMortgage_Mason (6)"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,___ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Wrm C3709 (R71 / 6-09)
S ! P�esaibed by Departmertl of Local Govemment Firence
ile M
INSTRUCTIONS:
Fwm wi .
To 6e filed in person or 6y mail with Me CountyAuditor or Counry Recorder o1 the counry where the property is located.
Fdirg Dates: 7) Real Property: Must fde durirg Ne year for which lhe deduUion is sought J N� Auditor
2) Mo6ile / ManuFactured Homes rat assessed as Real Pioperty: Must fi7e dunng the nveNe (72) rtanths �
before March 31 of each year the deduction is sWrtJhL County Remrder
C�
See 2verse side 7or additional instructions and qualilrcations. ( �
I������� ���� fe���s� �e� GIBSONCOUNTYAUDITOR
'i Ta ' Distrid Key number / legal desai Uan q¢�piy ep�mpp,r Page number
' - - - - D00• $6S-Oei
�. va4ie d mal praperty as of Mortgage / Contraa'vWebteCness unpaid as of Mortgage f Contrari ifWeMedrress unpaiE as of is Me aPd��t e sole
'Mertf� 1, anent year Mamh 7. arten� yeer da[e of applintion legal w epuibWe ovme/t
S � ❑ Yes ❑ No
! If no, wha�'s his / �u esact share of interwt? If ovmed wiM someorie other Ihan spouse. iMicate with wMm
I If name on 2cdtl ¢ tliRerent t�an ihat o/ appfimnt, trMi�ate 6ebvr. Is Me
praperty in QuesUm: Mnua�y Asrssed
� ❑ Rea� Prorenv � �^^�`i �
M1bble Fbrtie QC E7.7-7
Name W mortgagee or mntract sHier �
Pddress ot rturtgagee w mntrad se�er (numbe� and mee4 �'% s+a+e. ard 21P code)
Name of assignee ar ather owrrer w hdder of mortgage
^— �—�_ _
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ACCress ol assignce (number ana stree; rify, slale, antl i .
Does epplinnt own property in any o1�er I 7� i ...��% las lhis deductim 6een requwted on property
counry in Indona? ❑ Yes ❑ No L i$} 5'�'i 1\ O. ./. .. .. �r curtent yeaR � Yes ❑ No
�
Card N (/�)/
Or�uction approved in tlre amount of. O• • . �-s li �.. . . . . . . .
zo zo ` S9, �sv . � � �
sy�awre d co�ry nw�� . cw�n '—` oa�e cmann. aar. r��I
I/ We certify under ihe penalty of perjury that Ne above anA (oregoing infortnation is W e and cortect afd that Me applirant is a resitlent of IMiana ard
� owner / ntrad buyer of ihe aforemenboned property on date application is filed.
', S19nyur Ys fl�Tfame) Date (morvh. daY Yaa�
Fulltfvtlent address W appluant (nuniberand streef, tlry, stare, antl LP mtle)
Person autlronzetl Gy tluty executetl Power of Ntomey M by IC 61.1-t2-0.7
Pddmss o( authorrzed person (number arN sbee( dry, state, and ZIP oode)