HomeMy WebLinkAboutMortgage_Perry (18)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear �
_ FOR DEDUCTION FROM ASSESSED VALUATION
• Sfate Fwm d3709 (R11 / 6-09)
` 1 Pr�aibed by DePa�M af Lafal Govemment Firence
Fi e
INSTRUCTIONS: 1.I �
To be filed in person or by mail wifh the CounryAUditor or Counry Recorder o( the county where fhe pmperty is locat��'v �:
Fitirg Dates: iJ Real Pmperty: Must file dunng fhe }rear Por which the deduction is sought ounry AudiNr
2) Mo6de /ManufaUured Manes rrot assessed as Real Properly: Must file dunng the twefve (72) mon��'
before MarcA 31 oteach yEar the Ceduction is soughG County Recorder
See 2verse side foraddifionel instrucUons andqualifications. G�BSON COUNTy qUDITO
�.
rwmGU / kgal
I va4re af real Wo�tY es ol I Mortga e
�,�n,�a, r��a, �,
f
rt 5 his / her uma snara of internst?
n remrtl's dAf�t U�an that o( aPp�ant, uWifate
O
unpaid e Mongage / Contract udehtednes
tlate of appOtation
tt owned wiM someo�» aher tlan spouse.
RecoN num0er � Page numMi
�a �sma�w��me�
le�l w eQUttable owneR
n Yes ❑ No
Is Cie property in Question: Mm�aP/ ALSessetl
❑ R� �oaenv 0 nm�,atNw�ss�
a�ae r� nc s�.
Nartre of mort8a9� w mntrad uller ��� ... _-- _
Atldr¢ss of rtart9a9� or mntraU se0rs (nvnba� and sLeeL �Y, sbte. aM LP oode) _ -� � ��1 �/"1
Name of assignee a otl�er ovmer w twlder of mortgage �F'`�� n
a nI� n (� �-T
l:i"I���
appliont vxn poperty in any oNer
y m IrMana? ❑ Yes �
� ���
clion approved In Ure amouN at
20 _ 20 _
iMe ot Counry Auditor
rt yes. wnat counryr
20 - � 20
ab� b -.��a3
20
20
� O�D�Y
Yes ❑
20
I I We certify urWer the penatty of perjury that the above and foregoing infortnation is we and correct and fhat the aDP��mnt is a resident of IrMiana aM
owner I contraa buyer af tha�emeMiwied properry on date application is filed.
I��aMeyeemers !uQ name� Date (rtianth. daY. Y88A
antl
� �tCf� L�'
Pason auNO�'ve�d Gy Euty
person (numbcrarMSbeelary.stafa.endLPcode)
Date (mon�h, daY. i��