HomeMy WebLinkAboutMortgage_Minnis." STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS c av ear
_ FOR DEDUCTION FROM ASSESSED VALUATION
State Form 03709 (R70 /11-08)
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INSTRUCTiONS: .J U I�1e3�� 2009
To be filetl in person or by mad with the CountyAUddor d fhe county wfrere the pruperty is located.
Filirg Dates: 1) Real PropeAy: Must fde during the yoe� fw which tfre deducfion is sought.
2) Mobde / Manufeduretl Homes not essessed as Real Pioperty: Must file dunrg tlre hveNe (72) mmfhs befcr� ejRtp�3�§I� year �
fhe deduCfion is Sought �� � `
See reverse side !or aeditiona� iruwdions aiM qua�ificatims GIBSON COUNTY AUDITOR
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Name d assigrree or other oKner m IaNer d mortBa9a
Address d assignea (number and sbcat, a7y, abb. ad LP code)
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es W Mortgape / faitraU indebteEnesa unFeid az d Is Ihe apdwsN Ilre sole
dafe a( applimtion , Iegal ar equitable vxne(t
� ❑ Yes ❑ No
owned with someo�re aher than s0a+se. inOir�e vnih rMrn
' — � �e vwaM � aues7ion: nmuaGy acsessae
.__,,,+�_(] Mnua�yAssessed
. ''"° Nortie (IC 61.1-i
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Wha� Tasing Oisbid? VW Utis AeCUGion been rey..___ .
COUNTY AUDITOR
Deduction a�roved'vi Me annuN af:
ZO 20 20 20 20 2(1 20
sqnawre d ca,my a,dtor ca,my oa�e (rtm�n, day, y�
I/ We certify uMer the penalty of pe�jury that N�above antl fwegoing information is true and correcl and that the applicant is a resdent of Indare anA
owner / mnVad buyer of fhe afarementioned property on date applintion is filed.
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F' res' ress ( or endC abe dh: sb�, a�d LP oodo)
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F�asan aulhased by dWy azecuted Prnver dAtlomey or by IC 61.7-/2-0.7 � Date (madA, day, year)
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