HomeMy WebLinkAboutMortgage_Thompson"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS hip Year
__,_ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn d3709 (R77 / 6-09)
��u. � Presaibed �y DePartmeN af Lo�l Govemmenl Frence
Mark
(�vsrRUCnoNS: FEB 7 ��
`�TO be filed in person or by mail with the CounryAuditw or Counry Recader o! fhe counry where the property is located. F� ��
Filirg Dates: 7) Real Property: Must file dunng Ne year (or which the deduction is soughL C-'�. �� q�d�
2) Mobde / Manulactured Homes rat asscssed as Real Property: Must file dunng fhe M1velve (72J monfhs ry
6efo'e March 31 of each year the deduclion is sought. C unry Remrder
See ieverse sitle (o! addifional instructions and qualifications. �
GIBSON COUN Y A ITO�
����,�,�,�
Matdi 1. tlarent year
If ro, whal is ha / her exaf2 sl�are
ildesaiption
-/���� � -�G J`
3ge / Cantraf2 "uWebted�ss unpaid as d
If rwne m reodd is &Rerent Nan that o( appGpnt, mdirate be6w.
Name ot rtqrigagee or conVact seller
orconvaa
ovmerorhdaerotrtangage
AtlCress o� assignee (number aM stree; tl1y, sfafe, antl ZIP mCe)
Dces applinnt own property in any o�her
counry in Indiaria?
❑ Yes ❑ No
amount
2� � 2�
arrl
If yes, what wunt�/7
COU
�
un7aid az d Is Ne aVG�t Me mk
legal w eWibble OwnM
❑ Yes ❑ No
someorie other tlan spouse, iMicate wilh whom
Whal Tapng D'atntl?
1UDROR � �
�
Counry
Guestion:MnuaOyASSessed
b ❑��M�
Nas N6 tleCUrlim Oeen ie0uesteE m O�Y
�� �w,,,,..��.p.d.� a(i r1._.._ .I-1_..__
l r�." ' v `SONI �CEj. /Z
JA�t�S
�
/ / -(�yy
I/ We cert'rfy under �he penalty of perjury Ihai the above and foregoing infortnalion is true and cortect and Iha[ ihe applinn[ is a resident of Irdiana and
owner I contract buyer of ihe afaementioned proDerty on date aDPlication is filed.
�re �awneh fiA reme) Date (monfh. daY, yaah
i� / cw
Person
slafe,
Pov.er of AttomeY w by IC
Pddress o(authwaetl person (numberantl5trcet, dry, state. antl ZlPCOde)
/�
�ace (monN. OaY. Ye�