HomeMy WebLinkAboutMortgage_Alston (2)^'� STATEMENT OF MORTGAGE OR CONTRACT I E� un Tovmship Year
_ � FOR DEDUCTION FROM ASSESSED VALUATI(�
.• State Fom <3709 (R71 / 609)
,�' ,u. ` Prew�bed by �ePartment a1 Lorei Govemment France
wsraucnoNS:
NOV 3 0 2012 File Mark
Fam f�eE with:
To be filed in person or by mail with the CounlyAWitor or Counry Recorder o� the county w�era�t¢,�.@�?4�'lggg located.
Fditg Dates: 7J Real Property Must file dunrg the year (or which the deducfion is sought. � (\� � �ounry Auditnr
2) Mo6Ae / Manufadured Homes irot assessed as Real Property: Must file dunng the fweAc� ( onfhs
before Maich 31 of each year the deduclion is soughG Caunry Recorder
GIBSON COUNTY AUDITOR
See reverse side for addifional instructfons and qualifications.
AoMKarAdowxrorcontrarthuver-seere5+i�ruru�reversesidel / i , n n
Name of morcgagea p
L
Addms of mwt9a9ee
Name at azsi�ee or �
counry
n�srtr.s*i
p(operry as N
,_�
stree4 ury: sbie.
assignce (numoei am sveat, ary, srare, ana tir caae)
2nt wm p`operry in any oNV If yes, wha[ muntyl
diana?
il ❑ Yes ❑ No _
atrount
vri� someone
`��%a P��SU
unpaid as of Ls Ihe eppdrant the sole
�gal or equitade ovmM
❑ Yes ❑ No
idtcate wltli whrnn
�perty m question: Mnually Assesed
PfOpefty ❑Armua��yPSeaed _
� f �i9,5�.�'� -
Dra�ver NO...�.-„�.„�.��. . °
.. L
Card i\`O. ....Jr„� ;1 S —
sted on P�Y
Yes ❑ No
20 _ 20 _ 20 _ 20 _ 20 _ 20 _ 20 _
Sigrenne d Coimb nueitor Caunry Date (nrmth, day, Yca�
I I We certify under ihe penatty af perjury that the above aM foregoing intortnatlon is We and cortect arid ihat the applitant is a resident of Indiana ard
owner I contracl buyer af the aforementioned pmperty on date application is filed.
�y�n,;e �o�yar: n,n,��) ( n, D Date (rsmth, daY. Ye�)
/
Pe�wn author¢e0 Dy duty exeafted Power of Atoomey or by IC G
Pddress otaulhor'¢ed person (num6erantl svae4 �+�Y. state, eM
J