HomeMy WebLinkAboutMortgage_Georges (4)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
FOR DEDUCTION FROM ASSESSED VALUATION
, Stata Fwm A3709 (R17 / 6-W )
S- g p�¢�iy¢tl by Departmenl af Lnml Govemmerd Friarce
File a
INSTRUCTIONS: n
To be filed in person w 6y mail with the CounryAudito� orCounry Recorder o� the county where the pioperty is located. F� ��1 !i 2 Q �Z
F(tirg Da[es: 1) Real Property: Must fife durirg tha year lor which the deduction is soughG Counry Auditor
2J Mo6de / Manufactured Homes lrot assessed as Real Prope/ty: Must fi!e dunng the tvreNe (12) months �•�.
before March 37 o/each year Ne deduction is sought. Ll Coun er
See reverse side for additional instructions and qualifications. GIBSON CO
Ap ( wnaror buyer-sea� re sida
in1.(l� �i)') �- l°l�/L��a�'� n �n,tli v.� �
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c� — i — vt�—c�vi . z
'�ortgage / Contraa 4dehtedness unpaid as of
rri� 7. wrtent yeer
rc ro, wnat 5 ns ! ner erarx snare or interesi")
It name m record's ddfuent Nan that ol app6cartl, 6tlkate 6elow.
Name of mortgagee or conttad seller
�nh,.
Name of assignee or oNer ownu or hddar of mortgage �
AAtlrnss of assignee (numDer arM slreet ciry, stete, antl LP code)
Dces applinnt oym procenY in eny other If yw, wha[ munt�7
munry in Indiana?
❑ Yes ❑ No
zo i Zo i �
as of I Ls Ihe aPP�t Ne sde
legal w equitade ovrt�eYl
❑ Yes ❑ No
spo�ae� hd'�te Wtt� whom
IS UIC OroPertY N QWSOOfI: MIIU2M ASC4fE
9F�e� Provertr ❑ i�rmuami w�sea
c� i ic. as a-�- � i, cQ
What Tabng D"strirl7 F1as Nis tledutli�
for artent yeaR
COUNTYAUOROR
ez��
I/ We cerNfy uMer Ne penalry of perjury that the above aM foregoing infomiation is W�
owner I contract buyer of the afofememimed property on date appfication is filed.
sted on P�Y
Yes ❑ No
.� � ag, 5m �
Drawer NO .a.�.� �.�?........ -
d
Card NO. � � ��' -
1Wy exeated Porer of Attortiey w by IC G7.1-72-0.7 ' I Date (monN. day, yee�
prlsm (number antl sIIeef, rity, sfate, aM LP mde) .