HomeMy WebLinkAboutMortgage_Dix^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
- FOR DEDUCTION FROM ASSESSED VALUATION
• StateFartnd3709IR11/6-09)
S I presaibed by DeOartment of Loral GovemmeM Fuance
INSTRUCTIONS:
To 6e frled in person or by mail wifh the CountyAuditor or Counry Recorder of the counry where the property is located.
Fftirrg Dates: 1� Real Pmperty: Must fl!e dunrn,7 fhe year for which the deduction is soughf.
2) Mobife / Manufactured Homes not assessed as Real Property: Must h7e dunng the tweNe (72) rtwnfhs
before March 37 of each year the deduction is saght.
See reverse siAe !or additional insWCGons arM qualficatbns.
(owrar ar G bN�'see res7riUioru m reverse sile) �
.�N ��(y"[j��y��[to�
Counry Recorder
a GBSON COUNTY AUDITOF
T Distrvi Key number / le9al desaiPtion RecoN numDer Pa9e rwmDej
��� a� -aa -i� -aoo -ooa,. l 3 -o �
d mal P�oPMY as ot
If ra, what I5 his / her exacl share o/ inte25t?
It name m rt.md'a d�Re�mt than ihat ot aPp�nt, cMicate beh+r.
Iame N rrortgagee a mnttarl seAer
Address of matya9re or mntraa se�er
� omg �,e� w
ati irdeb[e0rress unpaid as W Mw�ga9e I Contraa mdet
ypar date of appGq�io{� �
� l0
If owned wi� sameorre dher ihan �
1
'w0� �I I
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ate, aM ZIP cade)
M stree4 �: �ta. ana ur coae)
enY «he� If yes. wFal
Yes ❑ No
Detluaion apprwed in ihe amount of:
20 20
SignaNre d Counb AW itor
e _T. y�
I/ We certify under Ne penalry of�
owner ! mntracl buyes of the aforer
Dy AWy execvtetl
eed permn (num
'o� 3 /,�4
What TB�d�g DuUitY1
COUNTYAUDROR
2t1 _ 2� _ �1 _
Counry
,
that the ve arW foregoing infortnaGon is We and cortec[
n2d D rtv on date appliration is filed.
ner of Atlort�ey or Cy IC 61.7-12-0.7
arM sbec4 �; slate, antl ZIP code)
�IJ
(epness unpaid as d Is Ne applkani Me sNe
legal a ewirade owreYt
(� O ❑ Yes ❑ No
Pouse. inEkate wiC� wlam
�I�
�en t J
l�QC.nrin C,
Z��
��l,q�s�•�
ao � a -
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