HomeMy WebLinkAboutMortgage_Harper^'�a STATEMENT OF MORTGAGE OR CO T INDEBTEDNESS Coun Township Year
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FOR DEDUCTION FROM ASSESSEDN��N� �
� S�ate Fortn 437091R17 / 6-W)
�' ,�,� % Prew�bed by DeparbneM of Lorai Govemmenl France
File Mark
asrRUCnoNS: DE� 1 9 ZO11
To be fi(ed in person or by mail wdh !he CountyAuditw or Counry Recorder of fhe counry where the property is bcated. F� �� �
Filirg Dates: 1) Real Property: Must file durnig the year /or which the dedu"�tlpnf' Counry Auditor
2J Mo6de / Manufactured Homes rrot assesced as Real PrupeRy: Musf ,e� unqg !he twelve (12J rtanths ❑
before March 37 ot each year Me deductlon isso� ht. V C\ County Recorder
VIBSON COUNTY AUDITOR
See reverse side tor additiona� instrucWns ar�d 9ualificafinns. (
1 rNmntradJtlYe�-see2 ' 1lPl��e) �-. /l. A �
Aisessetl vapie c( real P�Y az d
Mart�h t, arrenl yrvr
It no, what a his /
legal tlescription ' � Reco�d numbrl Page n
_i5'-3�-v�-000.�03� aor� %lS�
xtgage / Contraa'udebtedrress unPaitl as of Mangape I ConbaG'vWebtedwss un7aitl as d Is Me aP�t Ne sde
vd� 1, � �/'! date oi appfratmn legal a equitaole v.v�mY1
� i'7 O� ❑ Yes ❑ No
If ovrtred with someorre oNer t�an spouse. indinte wah vAqm
If name m mmtl is 6fierent Nan Ihat of app6canl. u�tlirate Celmr.
ryam¢ of morcgagre or mnttaU seller
Address of mortgagee w contracl se�er (nwMer and streef, ciry, s
Name of assignee w
naaress or
Du¢s appli�N own P�oPenY �n any
munryinlnaena? ❑ Y�
20
approvea m u�e amouni or.
20
I I we certiry under ihe pi
owner / cantract buyer of
Pawri aWOrizrd GyOWy
mortgage
� o ►, .�....
pl•��vcr �O. .
Card i�0• ...I i .-z�. (.°•........ •
the above
DroPertY a
�
orWIC6'
PdtlreSS of aNhorized person (number aM Sbeet �'/N. �fe. an0
20
Caunry
IS MC W�Y 1I1 GIICVAII: M11Ud�N ASS25524
❑ Real Property ❑ Armually Assessed
Modle 1-lat�e fIC 6
� �����
(a cvrtenl �maY.+
20 20
���� «� �
❑ Ye5 ❑ I
20
regoing informalion is We and cortecl and that the applipnt is a resident of IrWiana antl
application is fiietl.
Date (rt�orNh. daY. Y�A
(rtronfh. tlaY Y��