HomeMy WebLinkAboutMortgage_Haight^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
,_ � FOR DEDUCTION FROM ASSESSED VAL�I� ��
• Sfate Form 43709 (R71 / 6-09)
� � Presaibetl M DepartmeM of Local Govemmerk Filw�ce
� File Mark
INSTRUCTIONS: � � ����
Form f�ed wkh:
To be fiied in person or by mail wifA the CAUntyAuditw or Counry Reto�der of the n ere perty is located.
Filirg Dates: 1) Real Pmperty: Must file durirg the year /or which fhe detluction is soughL �County Auditur
2) Mo6ile / Manufectured Homes not assesced as Real P`opeRy: MdsT +�tlMA�iAyeNe (12) months
be(o�e March 31 o/each year the deduUion rs sought. v r\ ❑ counry Recorder
See reversa side for addirional instructbns and qualifiwtions. GIBSON COUNTY A D TOR
Tari ' KeYnumDer/kgaldesmPtion - U Record Pag
a G-� 8-36-abti a. �o-oa �( �
Avessed vaqc d 2al poperty es ol Mortgage/ Cantraa inde6tedness unpaitl as of Mongage I Contract uWe6teEriess unpaid as d Is Ne app�nt Me sde
i 7, wmv year Memh 7. airrent yeer �ate ot aOP�� Iegal w aWliade owneR
� ❑ Yes ❑ No
II m. what !s his / her exaG share of interest? H awned with someorre other than spouse. indrcate with wMm
It nane m�emrE's dAfemnt IAan that M aOP�j. md'wate belrnr. Is Ure P�P�Y in auesnon: MmiaAy Assessed
❑ R�i a�o�rty p nm,�iy w�
��v� � �� ���
d rtartgagee ar mntract se�er (mmiber and saeeC �y, sb:e, arN LP ooda)
Name ot assignee or othu awner w holder of rturtgage
AOtlress of assignee (number eM atrea{ rdy: stete, antl ZIP code)
\
C '"�+� rnoperty u+eny dlcer If yns. what t
� �
_' _�] No
/-�/��,v� - -
' � ��E'g,�oo�., � -
�G-.�-sa,� //�
o�Q//-��� —
11�
I I We certlfy u� __ ave ry
rnmer / wntract buyer of the atom�....._ _ rty on�
SlBnature (ow�ers h� r�ame) —
l% C/
Fup revdent address ol appGmnl umDe ntl sbee4 �1; �te, aM
�
Pason u0ai¢eE M duly ezecutetl Pw�er al ActmieY a M IC 7.1
person (n�mberaM sLee4 my. sta[e, an0 ZIP mtle)
COUNTYAUDROR
2o zo —
Caunry �
YP�
p_
Date
on praprlly
❑ No
20 _
I �i �bU.I.�L. I V 7—V / �/ /
infortnalion is We and mrrea and that the applicant is a resident of IfWWiana arW
ion is filed.
Date (rtmfi, daY.Yea�