HomeMy WebLinkAboutMortgage_Wallis"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 63709 (R71 / 6-09)
S,,,, a�eee cY oeu��u a�m c,���u F�
�srnucnoNS:
To be filed in person w by mail wifh the CountyAudifw w Counry Recorder o/ the counry where the property is located.
Filing Dates: 7� Real Property: Must file dunng Ne year for which the deduction is so�gh(. �
2) Mobde / Manufactured Homes not assessed as Real Propeny Mus! file dunng the tweNe (72) months
6e7om March 31 of each year the deduction is swght.
See 2verse side far addifional insfmctions antl qualifiwtions.
oama
f ab - Il �-3�- yo3- o00 •r�i -a'�`l
i real pioperty as d t Mort9z8e / Contract'vMebteEness unPaitl as o( Mwtgage I Contract
Year � Mar� 1.P�RY�{ Y� � date of aGP��b^
If rwne on
Name m mmea9� «convaa seuer
nearess w �rtqa�e «oo�o-aa �o
Name ot azsgnee or other ownu or 1
aDP��l "oMinte beb�r
stree{ cdy, ffite. arN ZIP rode)
Address ot asvgnee (number and shee4 �+N. sbta, aM ZIP roEe)
Oces appli2nt own yopeM1y in any oNer If yes, what munry?
counry in InEiana?
❑ Yes ❑ No � �
20 � 2�
I/ We certify uMer the p
ownef mntract buyer of
Pe�son autro�E Gy duy ez[
Pddress oi aNhaved person
What TaArg Dislrict?
W ac.�s, GaA D E
A-sNCE� �cJ
� �-�a33
ientioned property on aarc
sLee4 u7Y. s+afe. aM Z!P i
o(Attameyor G7.1-12{
's�e; ciry, stare. aM LP coc
��AUCitor
Counry Recorder
GIBSON COUNTY AUDITOR
of is Me eppfxsnt ihe sde
legal a M�ilaHe v.me(?
n Yes ❑ No
Is the property in VueVm: MfwwaP/l�ssesseC
❑ Real Property ❑ MnualyAssessed
Moble Harne (IC 617
Has Na dedutlirn Eeen reQUested m pmpeny
forartentynaR � .. �
� I �
Date (rtanfh. AaY• Yea�
ard that the applicant is a resident o( IrMiana aM
Date (monN. tlay. Y�h ' _