HomeMy WebLinkAboutMortgage_Fields"'* STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship vear
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R71 / 6-09)
�' w. Presuibed by Departmertl W lnml Gm�emmerit Firunce ,
�
INSTRUCTIONS:
Form Aed with:
To 6e filed in person or 6y mail with the CountyAuditor or Counry Recorder o/ Ne counry whele the pmperty is bcated� E r .� �2 Q 1 Q
FiNng Dates: 1) Real PropeRy: Musf file durirg the year /or which !he deduction is sought. �' C�ounty Auditor
2) Mobile /Manufactuied Homes rat assessed es Real Property: Must file dunng the twelve (72) months
6efae Mamh 31 of each year the deduction is sought. ❑ County Recorder
�7 �
See reve " e Ior addrtional instnrctions arni qualifications. `' I�`
nvp�n �cmvactbuyer-see mrererses�tle GIBSON COUNTY AUDITOR
b Disfia . Key number / Iegal desaiplion , RetorO number Page numCu
-,3 -/,3- OD - o0C7. (o - p DO S
AsresuE vWUe d mal popaty a d Mor(qage / Cantrsti inde6ted�Ts unpsid as d Mortgaqe I Contraa iMebtedness unpaN as of Is tlre appWant Uie sde
Mard� �. a,mn yar nW�a, �, w�^i C� 00 V aas ar �Garxauon � a�Nmde w„ier?
`1 ❑ res ❑ No
n no. wnat is nis � ner e�a share a interesC? rc wrt,m vriu, �meorre mce. man sv�. meKate rin, wha„
If rwne m record is Sdferent than mat ot applkant, uidinte bebv` ,I�s tl,,re�`°perty in quesaon: Mnuely Assessetl
L'4 �� �PBnY ❑ Mnually Assessed
0.bdle Fiartie C G7.1-�
Nartre of rtrutpagee or rontrari seYer ' ��, ���� � /^
-�-�„„'C� �_ u -
Add2a d nwrtqagee w conbacl se0er (mmibe� and sheet �'/N. stete. and LP code)
Name af assigncre or dhu owner or hdder M nwrtgage
anaress ot assignm (numaer ane street �r. smfi. arie z�P ooee)
fi E 3-�.- a �
Ooes appliwY own praperty in any otlw tt yrs, what muntyl Wtat Tari�g D'stridl Has N"a deduclim been reduested m pfoperty
munry in InEau? ❑ Yes ❑ No fw ament year? ❑ Yes ❑ No
COUNTY AUDROR '�-T�S r�i/r, Qa, s
Deauction app�ovad'u� tlre amount aE �
�_ � � Zo_ ����— i� 95 -
Sigreture of Camry Autlitor Caunry
1/ We certify urW e penalry of perjury the above anC foregoing infortnalion is true and corteU and t�at Me apP���nt �s a r,;,,ti,,... _ ind
wm ntract buyer o( the atoremerrtioned property on date appiication is filed.
Sig '( f�ID ) Date (nwrfi. daY. Y��
�n resaam maress o ppf (numDer aM sbec4 m}; state, e� ZIP ootle)
lo2Dlo S. S nl CZZ �n� /�T(ol�D
Person au1Mi¢e0 Oy duty ezewted Foner of Alfm�eY w M IC G7.1-12-0.7 Date (rtm(h, day, yea�
Pddress of auQmr'ved person (numberarid sbee; d(y, state. an0 2/Pcode) . '