HomeMy WebLinkAboutMortgage_Bartley (3)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS u sn� vear
:i"' . ,
, FOR DEDUCTION FROM ASSESSED VALUATION �
Sfate Fortn 43709 (R11 / 6-09)
�' w. � Presmbetl M �eP���rt ollocal Goremmerrt Finance
�NSrRUCnoNS:
UEC 1 7 �Q»a�
Fortn hled witA:
To be filed in person w 6y maii wdh the CounryAudifa or Counry Recortler o/ the counry where the pmperty is located.
Filhg Dates: 1) Real Proparty Must file durfig the year (or which Ne deduclion is sought `�%la,,,� unry Auditor
2J Mo6ile / Manufadumd Homes rrot assessed as Real Pruperty Must fiie dunng the hvelve (f 2J �th`s �^ r^,;�
beforeMarch3fo/eachyenrthedeductionissought GIBSONCOUN Y IIU1iTyR�O��
See /eversa side for addifiunalJ"pc�n.etions arM qualificatiorrr. �
AooGCan1(owrerorcontraC6 r- mreyerseside)
Sed raNe U real pfopa:y az d
1, aimLL yrar
tt no, what is ha / her exad share of interest')
rartie an rem�tl a N1te�m1 Nan tlfai
:'��r i
Address of rtiorVja9ee or contraci seAer (manDer end street mY.
Name of assignee w aher owner w MNU of morogage
VV O•�(l ` �.+�/CJ Retord num
unpaitl as d Mortgaqe / Cmraa tritlebteGi¢s �m7� es d
�'1v1 Eate ot aPP��
3
3. aM ZIP tode)
AOCress of assignee (number eM atree4 mY.?�� �� �
� 3P,�� �YI ��u unry? WhatTa�dn
— �E,r���f'�- 1'
COUNTYAUDROR
����,�0��
ttor
I We ceN uMer the nalry ot
owner! qin _ d l�uyer ihe afw
%Q�/��� S �i SUE �
Person a iho�aeE Ey EWy ezewtetl Power ol Attorney
20 _ � 20
Caunry
Ne above and furegoing infortnaUon is
property on date applicatlon is filed.
� �
state. eM
SliBeC �1% sfaR.
spouse.
Pape rwmber
4nca
Is Me appfxant ihe sde
legal «epuitaWe o�me(1
❑ Yes ❑ NO
IS UIC P�V�Y 1I1 G�M: MM18P� AiSC5524
� F2e21 PfOpEffY Q Mnu211yPnessed
Mobile Hort�e OC 61.
Has Nis deduGion been reQUested m property
for tuirem yYaR I-'1 .._ _ I-'1 �
20 � 20
� LL�T J��A L6/V 'I oa�e (�r�vvn, d�y� _I � I�
and cortect arM that Me apPlirant is a resident of I�iana aM
Date (rrwrWi, daY•Yaa/)
o� �„�rn. aar. r�n