HomeMy WebLinkAboutMortgage_Daisey'�� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-._--:
; FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R77 / 6-09)
�,.,. ° PresaiGetl Oy DepartmeM of Local Govemment Fnanca
INSTRUCTIONS:
To 6e filed in person or by mail with [he CounryAUdiler or Counry Recoider o/ the counry where the property is located.
Filing Dates: f) Real Pmperfy: Must file durng the year for which Ne detluction is soughf.
2) Mob�7e / Manufactured Homes iwt assessed as Real Property: Must file dunng fhe M1velve (72) months
6efore March 31 of each year the deduction is sought.
See reverse side 7or additional instroclions and qualifrcations.
Appbcam(oxi�orcontrarl6N'er-seeresniUions.qprerelsCe) � � I�f\ n
r i � �-� �
p�pe.+ry as a
no. what is ha I her exxt
�er/legaldesaiptioo �
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hbrtgage / Cantract intlebtedness unpaid as of Mortgage / Contrart
Mamhl,Wrtenlyeer ddte0/appfrcation
I7 name m remrC is difterent Nan that ol a0pficant 'uWicale below.
seller
contraG se�er (number and sfreet, ciry, sfale, aM ZIP code)
Ooes applimn� ovm property in any oNer
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❑ res
ictiw� approved in ihe amount of:
zo 20
Signawre of Counry AuEitar
� �C6hMy Filtl�
�.'J.�4:�Recorae�
GIBSON COUNTY AUDITOR
artl rwmbri Page number
y
uA az oF Is ihe appl'manl the sole
kgal or,� iRade o�mM
LT}Yes ❑ No
if awneE xiM someorie aher Man spouse, iMimte wdh whom
51ate, antl ZlP cotle)
If1�es�whatmunry? W�a�'
I�O
COUNTYAUO
zo zo _
Caun�y
�I tM P�7�M in Cuestirn: MnuaDY Assessed
teal ProPenY ❑ �!TM!;�N�d
e
.^m DlsUict? _I � EeEWion Eeen OesYes� P �p"�
� � S�� �G e�r� K�
84,w( �- �1�C1�
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I/ We certify urWer Ne penalry of perjury fhat Ne above anC foregoing in(ortnalion is We and corteU and ihat Ne applirant is a residem.....rcliana and
wmer / contract buyer of the aforemeniioned property on date appliration is fiied.
'�retu[a(ori'^n/'s fiR ^sme) . _ ,✓1 n _ . Date (matn. dar. Wa�
�71�3
�
Date (mmN. tlaY. Yea�
Pdtlr�ss of authpuEd person (numDer ared sbee; ciry, slate, and ZlPfode) _