HomeMy WebLinkAboutMortgage_Dupps""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS owns p vear
FOR DEDUCTION FROM ASSESSED VALUATION
S1ate Form 63709 (R10 /17-08)
� � Presaibed by DepaM�ent af Lor� Gwammerd Fimnce
INSTRUCTIONS: FIB
To be filed in persan or by mad with the CountyAWilor d the c»unty where Ne property is located.
Filirg Dates: iJ Reel Property: Must file dunng the yeer /or which fhe deduction is soughf. a
2) Mo6de / Manufecturatl Homes rrot assesse0 es Reel Property: Must file tlurnq the hveNe (12) months De�e Me� 1 0l eadi year
the deducfion is sovghG GIBSON COUNTY AUDITOn
see reverse side far add�tional irtsWdions end quarrficaGOns
iiAVP�/i��`I (ow.nerIv^mNa(�Ydryw-s/ee/��aru mreuv�m �� ����� /)
! /[�A�i /JI � / l� G� /:.Jt�a.II.N�Y
Key rwmher/ legal derry
aG -1y-�8-
Mart�h 7. amaN yea
N ro, whaf q his
If ipl118 M RWE R Q�BfBN �M12f1 �IIdI W 2GP�� IIIEIQIB CBION!
oy-DOO. � 3 _oa7 �on9 /8(5
u] iMebleOness u�aid as d Matgapa / Contraq in0ebteEness un�sid as d Is Ihe apqicaM Na sda
rear/ date of a�fimtion legal n epuRable awieR
(� QOO ❑Yes ❑No
If owned with mreone ahar Ihan spouse. uidc�e wilh Wvn
li tl�e P�W�M in Gue9im: AnrwaPy Aasassed
❑RealPruperty ❑MnualyPSSessed
Name d morigagea «mntred seAer
�3n'�.4G
Addrass d mort8agea u mriraci sa0er (ntmMranC sLOeC �: �4 aM Z!P code)
Pddress d aniBnee (rwmbfr antl strecf. p7y, sfad�, aW LP mtle)
Daas appGranl own popeRy in atry other if yes. wtut muNy?
raun[y in IMpre7
❑ Yes ❑ No
�
I/Wec
owner/
20 I 20 I 20
_.�
Drawer NO.. o�.�..�..� .....
Card \O. .. ��15.........
� ��,Qa�' � —
20 20 20
Y�)
N
� No
under the�nalty of perjury �h�fhe above and foregdng hifartnation is We and cwrecl and that Ne appGCant is a res0en� of Indiara aM
aft buyer f Me aforemention property on Eate aPDlication is filed.
j �m,a,nel i/I � ,-, _ oaca (,rrorwy e�r. r�)
<
Addrass d aulhorized parson (nu�nbr arW sfree(, tity. sbfe, arW LP mtlo)