HomeMy WebLinkAboutMortgage_Mann"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T nip Year v
_ ; FOR DEDUCTION FROM ASSESSED VALUATION
Stata Fartn 43709 (R71 / 6-09)
S f PreWibed by DepaRmefH o(LOCaI Govemment Fulance
' Mark
wsrnucnoNS: APR 2 9
To be filed in FO� m� �:
person or by mail vrifh the Co�ntyAudito� or Counry RecoNer of the counry where the property is bcated.
Fi7irg Dates: 1) Real Property: Must fJe durirg the year for which the deductlon is sought - C- J County Auditnr
2) Mo6de /ManWactured Homes rwf assessed as Real Property Must fiie during the IweNe (12) months
belore MarCh 31 of each year Ne deduction is soughG County Recadu
See reversa side 7or addRmnal instruclions arM qualifications.
GIBSON COUN
I M0��1(gyner oroontrarl6uyer ;� ee resLir�ons m re�.xrse s+'tle) .
��T
��d����
1, nmv�t year
ro.
��
Key
hu e�act share of intrlest!
Nat
' I legal desaiption R¢corti number Page numbPi
-3���`DY-000, yao-�� o�l /9�3
�9a9e / Contraa iMeMed�s unpaitl az W Mortgage / CmSaf] uWebtetlness �mGaitl a d Is Ne aGP��i the sde
March 1. a�rtent )mar Aate M appfip[bn legal a epuilatle mmeY?
�y (�Da ❑ Yes ❑ No
If owneE with someone other ihan spouse, irMimte wiTh whom
Name W mortryagee a mntrad se9er �/ �
Pddress of rtwngagee w rmtrad se0er (number eM stree4 �Ry. sble. aM ZIP code)
Na're W a5signee or oUtn owner w halder ot rtqrtgage
Mtlress ot assignee (number arM street �; slefe.
�l� l�
Ooes aPDWmnt o+m pmperty in any oNer
munry in IMana?
❑ Yes ❑ No
Dduraon apprwed in the amount oE
C$Uq:Y�/nl114YLH:7
20 � 20 � 20 _ � 20 � 20
Is the Wo7enY in Vuestion: Mm�aOy As,essed
[�'heal PioPertY Q Mnualy Assessed
for
Df:lll'�I' �`Q....� �/
�'I
SignaWre of CounN Auditw Counry .
CaYd � �
� -�r Y�-���-�� � ��o. ...1 �i
.....3:....
I I We cerlify under the penalry of ury Nat the a ve and foregoing infortnation is W e and __ �4 /��1c m� •..,
owner I mntraU buyer of ihe aforemenUoned property on date application is filed. "�(" �. v`''
signaWre(own_q'�fu0name) . Datelnar@1daY.Y�
Fu0 resi0ent 4CCresS of ap�nnt (number antl stree4 m}: state. erM ZIP od
/OI S �,Jelrnr' lir , flqvbsf4dt
Pe1sm aufhaaetl Gy dWy esewted Power of y w Cy IC G7.1-72-0.7
person (numbrs aiM sbee; city, shdfe, and LP mde)
�1%