HomeMy WebLinkAboutMortgage_Barnes Jr STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS v�tsfli( Year
uFOR DEDUCTION FROM ASSESSED VALUATION Cr?^�� { gg�¢—�i
State Form 03709(R71/6-09) I
Presmbed by Department of Local Government Fuw¢e
INSTRUCnoNS: JUL 11tS 3_ _To be filed in person or by mad with the County Auditor or County Recorder of the county where the property Form tiled with:
ry ry p party is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. ditor•
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months �r�2 rd
before March 31 of each year the deduction is sought GIBBON COU Y I oJIIUR
See reverse side for additional instructions and qualifications.
Ap t wrier a contract buyer-see restrictions side)e
Ta 'rg District Key number/legal description (/ Record number Page number
?,�. a6 — 19 -/ 9 - 103 - 00/. / 89 - o ) , a0 / 3 337Y
Assessed value of real property as of MMortgage/Contract indebtedness unpaid as of Mortgage/Contact Indebtedness unpaid as of Is the applicant the sole
March 1,anti year Maarrrrhh 1,aurent year date of application legal or equitable owner?
I Q� 670 0 ❑ Yes 1:1 No
If in what is Ns I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below ` Is the property in question:Annually Assessed
❑Real Property ❑AnnualyAssessed
- Mobde Home(IC 6-1.1-7)
Name of mortgagee a contract seder /t - • _ e ZA
Address of mortgagee or contract seder(number and street,dry:state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of 'gnee(number}}}}and troy,state.and ZIP code)
Does applicant own pmpe7/ any other 3
rr If yes,what county? • What Tr-m District? I Ras this deduction been requested on property
county in Indiana? ,,LL�e--JJrr ❑ No .. ••••n••^nt waR—�I-I ..-..._D No
Yes
COUNTY AUDITS Drawer NO ab1-)Th
Deduction approved in the amount of _
20 20 20 20 Card NO. 3 )3—\y
. VOL\x . 0\.
Signature a Camty Auditor , // County
I/We certify under the penalty of pejrjtury ythat�the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(owner's lull name) Date(month,day,year)
uff resident address of applicant(number and street,city,state,and ZIP code)
798'9 S 4,rdg6 / r r, 1 .1.4/ albs pr
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .