HomeMy WebLinkAboutMortgage_Thompson (6)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year D
• FOR DEDUCTION FROM ASSESSED VALUATION ,�
� State Fortn d3709 (R71 / 6-W)
S � PresafGed M Departmen[ o( Laml Govemrtrent Frerze '
File�Ntar�C�
INSTRUCTIONS: etl
To be �led in person or 6y mail with the CountyAuditor or Counry Recorder o/ the county where the property is located. O� F [��
Filing Dates: 1) Real Property: Must file dudng the year (o� which Ne deduclion is soughL County Audiwr
2) Mobde / Manufactured Homes rrot assessed as Real Pmperty: Must AIe dunng the twelve (12) rtwnthsC ��� — —
6etore March 37 of each year the deduclion is sought. Q""County RemAer
V c'\
See2versesideforadditiunalinsfruclionsarMqualifications. _ GIBSONCOUNTVe��� __
, - � .�
��oirralp'openyasoi h1or(page /COntraau
A1a�rh 1, aarefrt year M3rt3� 1, turtenl year
If m, what Is his / her erM share of infeJest?
If n2rtie an rt�ord'S tlHfe2n� Nan Ihal of applifant, Ind'uate C¢low
Name of rtart9a9ee or crntrar� seUer
Pdtlrea of mat9�Jee or mntrad se0w N end 4�, state. z
Name al assignee w other owner or twlder ot mwtgage
Addrew of assynee (num6e� anO street �; �te, an0 LP co0e)
Does applirant avm pmperty in any oNer U y�
munry in IMiana? ❑ Yes
❑ No
DeAumnn aooroved'u� ihe amounl oE
20 � 20 � 29
r���
3. �i �%- �07
iifable rnm�?
Yes ❑ No
If owned wi� sameone Gher Ihan spouse, ifMicate wtth whom
�RIs pmpertyinpuestim:MnuaMASesseG
ea�ProveM ❑.amua�yassessed
�l/1 n �An.�f ',iL'_'/ //1 /�/�
� tletlumon Eenn
Dran�er NO...... ��a`...... =���
Card NO. ......Jq��.....
20
Date (maith. daY. Y��)
C�Y
❑ No
20 _
I I We ceNfy under Ne penalry ot perjury Ihat the above arW foregoing infortnaUon is We and mrtect and Nat the applirant is a resident of Indiana and
owner I conVact buyer of the afinementioned property on date application is filed.
�Fu0 rrsiEent address of appTaant (numbFrand sbee4 aTy, stafe, arM LP m
a�R� nl m����z 2�ro L�/ ��.
Pn�son auU�orrzed Gy duly exewtetl Poxer of MmieY or by IC E7.1-72-0.7
P4dress ot author¢etl person (numDera� stieet �Y. s+ete,
o.� /,�/ u 7� 7 C�
Date (nantli, tlay,