Mortgage_Wallace (13)_^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court
_ _ FOR DEDUCTION FROM ASSESSED VALUATION
� State Form A3709 (R77/6-09)
, ° Prestn"betl by �epaM�erd ol Laal GoremmeM Fnance
wr
wsrRUCnoNs
To 6e fited in person or 6y mai/ wiN [he CountyAuditor or Counry Recnrder of fhe county whe2 (he property is located.
Filing Dates: 1) Real Property: Must file dunrg fhe year for which the tleduction is sought.
2) Mo6ile /Manufadured Homes not assessed as Real Property Must fiie dunng the fweNe (72J months
6efole AAarch 31 0! each year the deducfion is sought.
See reverse side !or additional instructfons arM qual�p[ions.
r�any o�a�a
nsessee vah�e d real popncy az oi
Marti�t.am�ntyPar
what s his I her erau share
If rwrie
w�� GIBSON
=ber/�gal tim y-o���a9�� D R��
O�
Mortga9e / Cantract'udehtedness unpaid az o! Mongage / Contraa uMebtedness unpaid az of
Mard)iprtqq(yeer_ dateofappGption
Name m mortvagee «mntract sener G+ S A
�� 1J
Address of rtnrtga9ee w mntracl se�er (num6er end sbee; �y, sbm, aM LP cade)
Name ot assignee or dher owner or hdder ot mortgage
naares5 rn assgnee �numuer am suee� ary, sraie,
Does ePWimnt ovm property
munry in Indiana? r
approved in ihe amoum of:
someane oUwi Nan spouse.
DCa11'CI" �Q ��. r,.........
c���a �io: � a.3�
Year
Yes LI No
Is the popeM1y in QuesUOn: MnuaDy Assessetl
❑ tteai �oaenr ❑ amuanr assessed
rnow� � nc s
Has Nis dedudion Deen requnsted m pmpeny
(OfWI1HNYP2(1 I—I ..__ I—I
zo � xo _ � zo _ � zo _ � zo _ � zo � zo _
1 I We certify under the penalty of perjury that Ihe above and foregoing infortnalion is We and cortect arW Nat the applipnt is a resident of Indiana arW
owner / contracl buyer of ttie forementioned property on date applica0on is filed.
7faw name) • ^ � Dala (montli. daY•Y�A
� �
K/�.tiC
" ent addrew of appGnnt (number �d 51rce4,�Y. �te, and ZIP ootle)
Cy duh/ exetu[e0
F.dCress of aNha'veE person (number arM sveet, ciry, sbte, arM LP oode)
Date (rtanN, tlay, yaa�