HomeMy WebLinkAboutMortgage_Daum STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
W-_ r,f• State Form 0.3709(R11/6-09)
Prescribed by Department of Kral Government Finance I,,1
Fie LE
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property Form filed with:
ty ty p party is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. A it oca,m3ditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought. - • County Recorder
See reverse side for additional instructions and qualifications. t7Irrirmii;
Ap or contract buyer-see restrictions on reverse • GIBSO COU`TY AUDITOR
axing Dii{\A wr��m�}('.�+�c Key legal desalt - Record number Page number
I-0\) `' Ti,Tia 1 a(re` O5 - 35c - flo,3 . 1 '19- t).3.7 IA 9 1S3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,arrest year March 1,anrent year date of application legal or equitable owner?
If no,what is his I her exact share of interest? ��J�� tf owned with someone other than sparse,indicate with whom yea ❑ No
If name on read is different than that of appficarv,indicate below. Is the property in question:Anrwafl`yAssessed
Property ❑Jf uaQY Assessed
Ue Horne(IC 61.1-7)
Name of mortgagee or contract seller
r_i Address of mortgagee or contract seller(number and street city.state.and ZIP... _ ry I 1 O (�e 1.
Name of assignee or other owner or holder of mortgage ^ \1 'I,V 1 �!j (�(1(�
Address of assignee(number and street,city,state,and ZIP code) &I)AlUSi - r �
Does applicant
in Ifmit awn property in any other If yes,what county? 1 ✓�+ L Fon property
mu in Indiana? lJ
❑ Yes No ❑ No
cou
$ 8900o
•S2
Deduction approved in the amount of.
20 20 20 20 /'— c7 20
Signature of County Auditor -
I/We certify under the penalty of perjury that the above and foregoing inf .. .. .. • - -pp(cant is a resident of Indiana and
owner I contract b��u_yyYpe�\fire\of the aforementioned property on date application __
Signature(o """°"N Date(month,day,year)
urresidel�t address of t(number and ary,state,and ZIP )
8270 let l tr r,nce�n . T� � 767U
authorized by duty executed of Attorney or by IC 6-1.1-12-0. Date(north,day,year) A
Address of authorized person (number and s+raer,cr0:state,and ZIP rode) _ , 1\