HomeMy WebLinkAboutMortgage_Selby^�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
+ FOR DEDUCTION FROM ASSESSED L�`A'�� 10
, • State Fwm C3709 (R11 /6-09) � � r .� �
\ aJL.J��
PreuribeO by DeP�menl of Local Govemment Friance
Coun Township Year
File Mark
��srRUCnoNS: OCT 11 2011
k be filed in person w by mad with the CountyAuditw or County Rerorder o/ the county wl�ere the p�operty is located.
Filing Dates: 1) Real Pmperty Must �de dunrn� fha year for which tfie dec�tt[Q�,�
2J Mo6de / Manufactured Homes not assessed as Real Propetly: Must un the tweNe (12) months
before March 31 ofeach yearthe deduclion is soughf.
SeereversesideforadtlitionalinstructionsarMqualilcatbns. GIBSONCOUNTYAUDITOR
Key rwmber / legal desaiption
a�-la-o8 03- ooa.. d�-o
Farm A�:
Counry Auditnr
❑ County Recorder
Assessed ra4ie oF �{aoputy as d Mortgage / Conbaa irdehtedr�s unpai0 as af Morigaga I ConSaa iMebtednrs imPaid az d Is Ne ePW�t Ne sde
1. cvmrt year Mamh 1. arteMY� ,�7� date of app6mtion legal n eQURade v�+�eR
jS�Livv ❑ Yes ❑ No
11 no. what fs his / her erarl shara of inte25t? If ovmed wdh someone other than spouse. indimte whh whom
It name m remN s dMerent Nan thal of aDP��� ��� ��' Is tl�e property in QuesUOn: MnuaAy 0.srsuE
❑ Rea� arovero ❑ nm,ua�y ws�ssed
Address o1 rtnrtgagce «contraU se�er
Name ol "`:s ee w other owner or hdder of mort9age
(number eM stree( cdy, state, and ZIP ootle)
any oNer � Ii yes,
and LP
L� O�
AeC m P��h
Yes ❑ No