HomeMy WebLinkAboutMortgage_Partenheimer^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
.;__ _� FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Form d3709 (R 77 / 6-09)
�' 1 Presaibed by �epartmenl of l.00l Govemrtrent Firence
a
INSTRUCTIONS:
To be filed in rsron or b mail vnth the Covn Audi(or or Coun Recorder o/ the coun where the m F� �� ��
a� r a n ty a a�nv;s��� FEB $�
Filing Dates: 7) Real Pmperty: Must !le dudng the }rear /or which fhe deduction is sought U�unty Auditor
2J Mo6i/e / Manufactured Homes no1 assessed as Real Pioperty: Must file dunng the Rvelve (72) months
6efore Marob 37 0/ each yeer the deduction is soughG ❑ Counry Recorder
See Ieverse side /w addiLOnal instructions and qualifications. �
Ap wner cantraU uyq- see m reverse vde
F GIBSON COUNTY AtiDliGn
Ta � n�, Ke ' OeN legal Oescn'Wion o�_ �. ��/— D� ^ Record number Paqe nurpYei �
i.L -CXD a CP I'� y
Assessed vahu d real popeny as W Mo�gag e/ ContraG irdehtetlnrss unpaid as d Mwlgage / ConraG indebtedriess unpaiE as of Is ihe epq'iwii the sole
Mamh 1. arrern year Memh 1, n�rtent year date of appfimtion legal w equitade oxnel.+
�i f10. W�12� 6�YS i �Iff fl(df� S�1dR
�} 112111Q p(� IyCpfd L5 Qf�iplg�l ltidf
Name o+nnngagee « cw,tra� sener
AGd� of rtartgagce or mntrafl se0
Name af asvgnee w flflther er or f
�JLX
Add`ass ot assignee (num6eiaM am
Oces appGfant wm yoperty in any a��
ca,Hyi��wranaa ❑ ves
Deductirn approved N Ne amounl at
r and stree4 uN. s7ate. arN i
ate, en0 Zl�—
It yes. what countyt
Na
zo i zo— i �°—
of Counry Auditor
NRat Tari�g D'atria7
20 _
/� i� O O ❑ Yes ❑ No
�erty in 9ue50on: MnuaDY Azs¢sed
Property ❑ amuany�ed
IF7as Ihs Ee�On Eern req� m p�opelly
�a�� ❑ ��_ o
Dra���er \i0.. 0�,00`�.......
c���a ��o. ..�.ya.y.........
$ / Si �i L
I I We certify under Ihe penalty o( perjury that the above and foregoing in(ortnation is We and cortect aM that fhe appluant is a resident of Indiana arM
owner / contract buyer of the afwemenlioned property on date applicatlon is filed.
�reWre (ownefs hAneme)\ . Date (monfh, day, yean
�..�.,,_.e �\ �t]n�.�..w_.i
\\�- z.hr�vrhRaiJC �C'�.c�eo,e,1 S�v
Person auUrmzed by dWy esecutetl Power of Attomey or Dy IC 67.1-12-0.7
P4dress of author¢ed person (numberantlSLee( city, state, and LP catle)
Date (monN, tlay, yea�