HomeMy WebLinkAboutMortgage_Meuser (2)'°+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES o T Year
= FOR DEDUCTION FROM ASSESSED VALUATION �
� � Sfate Fortn d3709 (R11 / 6-09)
�' ,«. f PresaiEed M DepartmeM of Loral Govemrnein Fu�ance �
wsraucnoNS:
JUL 0 9 "[�1i�uMa�tc
To be filed in person of by mail wifh the Counry Auditor or Counry Recorder o/ the county where the propeAy is located. F� �� ��
FiPog Dates: 7) Real Prope/ly: Must fde durirg the }rear fw which the deduclion is sought '-yy� vj� County Auditor
2J Mo6de /ManufaGured Homes not assessed as Real Property: Must file durng the twelve (f 2) ryontlra� �v�
before March 37 0( each year the deduction is saght �/ Counry Remrder
Seereverseside/oradditionalinstrticfionsarMqualfications. GIBSONCOUNT AUDITOR
nppfu-em (owner oroontrep buYer, sce rr�Mirctons m reverse sida) .
Tatircj Distri� // I Key rnm,ha, kgel d�,
�/ a�-� a-o�-�a 3- o� a��5oa -G
Aswssed raWe af real PoG�Y as d Abrtpag e/ ContraU Webtedness un7aid as d Matgage / Contrar3
Memh 1, tl�rt yeer Mert3i 1,�Wrte�rt yPAr tlata of appGption
tl no, what Is ltis l lrer euG shaie ot intemst/
tl name on recroN b tliRe2nt Nan that of appYtant,
�Name W a contract sepn
/1nlaCL�
ACdrea d mxogageE ar mntraa seDer (nemDer e
Nane of assi�ee w� awner or holder of
AdE�ess of assignee (number eM shee4 ary, stete.
Dors applimnt pm poperty in any ather
couNyinlrNiana? ❑ Y2s ❑ No
DeducGan aoomve0 In tl�e amaum oE
20 � 20 —
tr�tlitate Dela'�!
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nd af, uy, smm. erd ZIP )
��e
antl ZIP catle) _
uyes.whatca,ntyr whacram
couNrrnuoROF
20 � 20
Counry
Reootd number Page numha
a�
btedness �npxM as of Is the appArant the sde
kgal or equttaNe ovmeR
❑ Yes ❑ No
spaiu. irM'�[e with xiran
(Ips th�e,p,,ro,�perty in Quesfim: Mnua%ASSessetl
V'."" RoGBKY ❑ ..�,.�.:� � � . _
Dra�ver Np., aDIO -
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Card i1'O.,'.. a,(Q 73 i
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2p— � 20— I 20
I/ We certity urder Ne penalty of perjury Mat the above ard foregoing infortnaGon is we and cortect arM ihat Ne applipnt is a resident o( Indfana aM
owner I contracl buyer of the aforementioned pioperty on date application is filed.
� " loane/s WVOarf�l . Date (n�. daY. YgeA
sta}e. anE LP mtle) �/ �/ D
�cr�!)h . Tn.
I�oReC �y duh' ezeated Porer of AH6mey or Cy
autlmr�d G� (numGer arN sbaeL �: slate.
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