HomeMy WebLinkAboutMortgage_Rose (2)^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN� -, oun nship Year
.___ ; FOR DEDUCTION FROM ASSESSED VA/�N
• . . �• Sfate Fortn d3709 (R77 / 6-09)
�� �' ,u. � Presrnbed by Departrterd of Loral GovemmerLL Finance
�c�" �p ile Mark
INSTRUC710NS: Vi �����'v/ DEI: 2 S 2
•TO be filed in person w 6y mail wifh the County Auditor or Counry Remrder of Ne oounty where Ihe pmperty is locafed. F� �� ��
Frling Dates: 7J Real Property: Must file during the year for which the deduction is sought. �J � Counry Auditor
2) Mo6de /Manufactured Homes rrot assessed as Real Property: Must file dunn [he M1velve s�
before March 31 of each year the deduction is sought 9 � ❑ Counry Recorder
Seeraverseside7oraddrtronalinstnicfionsarMqualifications. GIBSON COUNTY A
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o�stria �. J I Key numeer
�.�d����
1. am�nt year
If no. what a ha / her erafl �are
f12(IIB IXI
.�.........� Y/ • H\ X� � � `l A 1 lXJ
Add2ss of nnrcgagee w mntrad 5e0er (nwMer arid sbee; rJly, 5ate,
Name af asvgnre w ahel awner rn hdder ot mortgage
AEaress ot assignce (number aM stree4 rih: stare.
6�ifant Own pmpeM1y in any oL
y in Ind'ana?
❑ Yes
iction approved in the amwnt oF.
20 20
I( yes. what count�/?
No
20
5om
W�atTa�dtg DiSlric
COUNTVAUDROR
20 20
Caunry
I/ We certify under ihe penalty of perjury that ihe above arW foregoing intortnatlon is We and c
owner / contract buyer of the aforementioned property on date apP���tion is filed.
adtlress ot appfaant (number and stree4 �', �te, aM ZIP coda)
Person auNOmetl by duh/ ezecuted Power of Attorney or by IC 61.1-12-0.]
R"�r�Pro� TN `{�2�0
Address of authaued pnrson (number a� sbeef, dry, state, an0 ZIP aode)
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ContratY uide6tslnoc� �.,rou
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