HomeMy WebLinkAboutMortgage_Meny"'+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
, FOR DEDUCTION FROM ASSESSED VALUATION
Sfata Fortn d3709/R11 / 609)
� t Presaibed M DepartmeN af Loml Govemmerd Fvance -
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INSTRUCT70NS:
b be filed in person w 6y mail wiM Ne CounryAuditor w Counry Recrorder of the wunty where the pioperry is bcated.
FiNrg Dates: 1J Real Pmperfy: Musf file durirg the year (or which Ne deUUCGon is sought.
2) Mo6de / ManulaGured Fbmes rat assesced as Real Property Mus! file dunng Ne Iwelve (12J marths
6efore Maich 37 oi each year Ne deduction is sought.
See reverse side 7�ditmnal instnxt�ar�p7F�a ficat6ons.
�
MaM 1. tlnPnt yPar
11 m� wfiat ts his / t� esa3
n � a, �c«a o dm�
nrtn6er / legal
mac a ava�t t�a�wce eerow
Name of mortgagea or mntracA seDer
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Name at assi�ee w oMg owner w F
AdCress ol assignee (num0er and sfn
property in any other
❑ Yes
ction approved in the amount at
20 20
AuEitnr
i/We
owner
��.
slate, aM ZIP ao4e)
If yes, whet muntyt
I No
/i�]
File
Year
L�V�ty Auditor
Counry Recorder
GIBSON COUNTY AI;DITOR
Remrd mimber Page number
-30� -doo .3�o-e � I o Co �
unPaid as W MoRgage / Contrxi'vNebteCness imPaid as d Ls ihe epp(rcant the sale
date of apptication kgal w equitade mmeR
)� ❑ Yes ❑ No
It owned wiN someane dher ihan spouse, trMicata ritli wtom
Is C�e poperty in question: MnuaM Assessed
❑ Real Rcro.+�-r_�.•-------ssed
_ _ pc�,.,-;
20
- �ao�o-t�y —
_ � '13,1�00. °= _
�c���d �� � —
Wh �Y
_ �� A ,� �
V � — 1 — �
penatty of perju � at the above arW foregoing infortnaliori n we and corteG arW that Ne appiicant is a resident of IrMiara aM
of the aforemen ed property on date appiicaCOn is filed.
� _ oate (monfh. dar, yeatl
aN.
Pason auUm�¢eE Dy dWj execute0 Power of Attm�ey w oy ic a�.t-iz�1. i
AOEress d autha'¢ed person (number aM sneet mY. state. and ZIP cade)