HomeMy WebLinkAboutMortgage_Marsh (2)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_. • FOR DEDUCTION FROM ASSESSED VALUATION
• State Form �13709 (R11 / 6-09)
,S �«� ° Presaibed by DeP��nl of Local Govemment Fnance
INS7RUCT10NS:
To be filed in rson or b mad with !he Coun Auditor or Coun Recorder of the coun where [he ro Fa
Pe Y N 4' b' P PertY is located.
Fdirg Dates: 7) Real Property Must file during Ne yea� for which tha deductlon is sought.
2) Mo6Ae / Manufactured Homes rrot assessed as Real Property Must fi!e during the fvreNe (12) months N O �
6e(o/e March 31 01 each year the deduction is sought.
G'J.
See reverse side /or additional in5trucUons aIM qualificafions.
Tating Districl
Assessed va4re of real @oP�Y az d
Ma�d� 7. aemR yrar
n ro. what Is his 1 her e�tact share o
rc�«��w�am��u�,u
- DS-31=u'� - Do0�4
Mortpage / Contrari indehtetlness unpaid as of
Ma� t curm�year
Name of rtnrtpagee or contracc seller "'� \
� �O rw w
�vci�i � • .�+�
Address ot mort9agce a contract seDer (number and sbee; ciry, state, aM ZIP wde)
Nama of assignee a other owner w holdu of mortgaga
slafe,
Dces ePplua^t own property in any oNer
counryinind'ana? ❑ Yes
❑ No
Year
County Reoorder
GIBSON COUNTY AUDITOR
/� /�� R¢a�rti numbei Pape numbel
� (' C.t7(
ngage I Con:raC Webtedness unpaid as d LS ihe epp�ont the
e Of appOCatnn legal or equitabie o'wne(/
n Yes ❑ No
sameone oiher than spouse, indircate with wln
� me arovemi �n a�es�
❑ R� a�oaenv ❑
Dra�ver \'O...o�(��,o?-;.....
c��-� �o. .. �05.7.......
,/D 8 �:c�. �
Has Nis dedudion Eeen requested m p�nperry
for anreirt Y�n � Yes ❑
zo_ zo _ i_ __ Zo_ zo_
sigrrdwre d Cow•ty nuaitor caunry oate (r�pnth, daY. r�ad
I I We certify uMer Ne penalry of perjury that ihe above and foregdng infortnation is we and cortecY arM that the applinnt is a resident of IrM'qna ard
owner I contract buyer of the aforementioned pmperty on date application is filed.
SignaWre (o nePa) . A �% A_ � Date (monlh. daY.1'eaA
c.."m!
Pe�sm aulho�.d by tluly ezecuted Power af AtmmeY or by IC 61.1-12-0.7 ' I Date (month,
Pddress o( authatred Pe� (numCer and saeet dty, state. and LP cade) .