Mortgage_Watkins�
�
�rySTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS � s' vear
, FOR DEDUCTION FROM ASSESSED VALUATION
� State Farm 43709 (R71 / 6-09) �
`„r PresrnbeE M�� 01 LoW Govemmetrt Finatxn
Fle Mark
�NSraucnoNS: 0 C T �
To 6e filed in person or 6y mail with the CountyAUditor or Counry Recorder of the county whe2 fhe property is located.
FrArg Dates: i) Real Property: Must fi7e durirg the year for whirh Ihe deduction is sought. [, , County Auditnr
2) Mo6de / Manufactured Homes rrot assessed as Real Prt�perty Must h7e dunng the tweNe (12� month� L�'Si :c
6efore March 37 oleach year Ne deduction is sought. l��nry Recorder
See reve�e side fwadditional inshuctians and queli6caUons. GIBSON CO
Aa�ed vahia d rr�l pfoperty a af
Mazfh 7, MCrt ym
tl ro. what Is ha I Mr e�1 share OS inteRSi9
tl narne m Rmtl 6 d�iterent Nan ihat
I kgal desaipbm
/ Contraci irde6letlness unpaid as d Morigage l CanRU1 mEebleC�ress imGeid as of I5 Ihe ��t Na sole
v yrar Cate of app�tion legal or epuuehle omN7
� �. /S'ff� ❑ Yes ❑ No
se0er (numher and shae4 �Y, stem. ard LP code)
assignee or a¢hei awner or haNar N mort9age
PLAress of atsi�ee (number eM a`eeL �N', s�.
Dces appfifanl ovm D�OenY
counrymind'ana? r
sPouse. udkata ritli xh�om
Is Cie p(operty in 9���: �nue0yl�sessed
❑ � aroxnY ❑ n^m;�in�sed
Yes. what munq? I NTat Te�dfg Districl7 I far anmt Y�n �� O �� G�G�Y
❑ No
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