HomeMy WebLinkAboutMortgage_Naas Eat. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Si 1 FOR DEDUCTION FROM ASSESSED VALUATIO
:_-ti*j�' State Form A3709(R11/6-09) I
S ;r'et Prescribed by Department of Local Govemment Finance
File Mark
INSTRUCTIONS: ��((``77 ,,(I ��((11�q
Pe by County County county Ht'the propeap orated. Form filed with:
To be filed in person or b mail with the Court Auditor or Court Recorder of the court wh +ST
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file duripp the hve (12 mon
before March 31 of each year the deduction is sought. ,l IL, ns County Recorder
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
( ..y!: t( ov
or °�° er-seee�res restrictions c side)
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61.6 -at)-o6—&oo-ooa•115-coi Record � Page /981
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sale
Math 1,current year Mardi 1, nt date of application legal or equitable owner?
415 Orn ❑ Yes ❑ No
If no,what is his/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 bebw: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
-
Mobile Hone QC 6-1.1-7)
Name of mortgagee or contract seller
QM.wI-
Address of mortgagee or contract seller.IN.a^`---- 'e) -
Name ofassi _/v I ) •..
Address of am
Draw-el• NO..C....`. l�/��/-y, ay
• Does applicant r 1 I - •••.••••' What Taxing District? Has this deduction been requested on property
county in Indian; Card ISO. • for current year? ❑ Yes
1 ❑ No
COUNTY AUDITOR
Deduction approved in the annum of
20 20 20 20 20 20 20
Signature of Auditor I L.l-1 Pf' County � Date(month,day,year)
J`SdnnJ ', V
I I e certify under the penalty of perjury that 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(ow h a 'iL+�� Date(march,day.year)
ms�l.e�b�t a"d���s of a t( caber and street. and ZIP code)
c7�Xl 1"1 s acanc,i cup , IIlb'49
Person authorized by duly 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)