HomeMy WebLinkAboutMortgage_Phillips (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
+ FOR DEDUCTION FROM ASSESSED VALUATION
. � Sta[a Fwm 43709 (R71 / 6-09)
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INSTRUCT70NS:
To 6e filed in person or by mail with the CounryAuditw or Counry Recader o/ tAe counry where the property is located. F
Fi7irg Dates: 7) Real Properry: Must fife dumg the year /or which the deduciion is sought. �r Coun Auditor
2) A}o6de /Manufactu2d Homes not assessed as Real Property: Mus! Re dunng Me twelve (72) morY1�6 2 9 ry
6efore March 31 of each year the deduclion is sought. J Counry Remrder
See reverse side for additronal insnuctions arM qualAlcations. C"��
Appfcam(owneroroontrdrtbuyer-see on2verseside) V
��a�� J 9( ��� �� 15 ��� GIBSON COUNTY qUD�7na
� � - -• - -- - � --- ..
� _o1D- 0100— ODI. SSo1—
Ats�sed vahie d real qoperty as W Mortc�a9e / Contraa irdehtedness unpaiA as W Mortgage / C<
Memh 1. nnent year Marti� 7. airtent year Eate af appGc
�
If rw, what is his I her ezaG share o! interesi? If owned wiN someone
It rwne m'ecdd'S dMereni Nan Nat of aDpGCant ���e bebw:
mort9a9ce a
Mdress of mwtgagee or mntracl se0er (num6er and slrae4 cey, state, aM ZIP code)
Name of asvgnee or ottrer owner w holder o( rtqrtgage
sLEe4 �1: �te(. 9aM ZIP cade)
/1 � i— O �.�, . Z.S I% �—'
D�OertY
iOL
spouse,
idade oMnell
Yes ❑ No
Is tM PenY in Vurstion: Mm�aOy AtwsuE
ea� aropero ❑ �^!!aM �
.�i
couNrr nuortort
De�uctlon apprweG u� tlre amount of:
za 2o zo _ 2o zo zo zo
sigrarure U cwnn nwltor county oate (,mvn. ear. r�d
� -T.
I/ we certify under the penalry of �ury that tne ve and foregoing intortnation is we and correct and Nat ihe applirant is a resitlent of IrWiana arM
owner f mntract buyer of ihe afwementioned pro rty on date applitatbn is filed.
`' Si9 re(oxne/s neme) � Date (nmfi. daY. Y88A
X ��
FWI resid atltlms d appf I(numberand shaeS �: 5t3te, and ZIP Cotle)
1 S I )- KI �-� tiltr
Person authorrzed Gy dWy erecuretl Power o( Attnney or by IC 61.1-1 .7 Date (monN, day, yea�
Pddrnss of authv'ved perswi (number ard saee4 dry. sfafe. end LP mtle)