HomeMy WebLinkAboutMortgage_Klump (3)"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ = FOR DEDUCTION FROM ASSESSED VALUATION
• $fate Fortn 43709 (R77 1609)
S j Presaibed �y Department o1 Loml Govemment Fnanca
INSTRUCTIONS:
To be filed in person a by mail wrth fhe Counry Auditor o� Counry Recorder o/ the wunty whefe the properry is located.
Filirg Dates: 7) Real Pmperry: Must fi/e during the year /or which the deduction is sought.
2) Mobi/e / Manulactumd Homes rrot assessed as Real Property: Must fi/e dunng the nvefve (72) months
befae Malch 31 0! each year the deduclion is tought.
See reverse side lor additional insVUClions and qualifications. _
;e3 vahre d rnal qoperty az d
1, wmnt yp2t
�� 110� M'�18� 6 �115 � ilEf E22fI S�IdlB Oi VI(CRSS�
Year
JU❑ 2�furg�iitw
❑ Counry Recorder
GIBSON
.7 —/ - UU - V �'�-�, - oJ - UO U(
Mortyage / Convan iMehtednass unpaid as of Mortgage / Cono-aa ci0ebteMrss unpaiE a d
March 7, airtent year da[e of appGcaCv��
1; owned with someone aher ihan spouse. indicate xtiM �
tl name on (etord "4 tlirterefll than Nat of aDP�ni, ind'uate belaw.
Name ot rtartgagee or rnnvaa uUer
rtprt9agee a
w otliPf owner or holtler ot mMgage
uam. a�e va �oee>
of assignce (number antl stree4 �Y. �te, and Z/P cotle)
Dces epplit2nt oxn peoperty in any oNer I If yes. what
munry in Indena?
❑ Yes ❑ No
Page num(beGr/
� T�
Is Ihe epptirant Ne sde
legal w equrta6le awnM
n Y� n No
Is IM praperty in Oueslb�v Mm�a�y Assessed
❑ R� a�oae�+v ❑ a,�,�,�nr a�a
a�odle Fiame.nc �+.�-
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I�.,� unren� yeaR ❑ Yes ❑ No