HomeMy WebLinkAboutMortgage_Lamey (11)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ ,; FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fam 43709 (Ri t/ 6-09)
��u. j PresvibeA by DeG��M of Local Govemmertl Frw�ce
�NSTRUCTIONS:
k be filed in person or by mail wRh fhe CountyAUditor or Counry Recnrder o/ the county where the pmperty is located.
Filirg Dates: 1) Real Pmperty: Must file dunng the year for which !he deduction is sought.
2) Mo6i(e /Manufactured Hanes rrot assessed as Real Property Must file dudng the fweHe (12) months
befae March 37 of eacA year the deduction is sought.
See reverse side (or additional instructbns and qualfications.
AppGrant ror cont`arl buyzr- see m m reverse side)
GIBSON COUNTY
Remrtl numb�
— Q� �
Township Year
File rk
wm ed with:
M 5❑2(��ry,�d���
❑ County Recorder
C.'_ ^^ . . .
seC rWue of real P�P�Y as d Moryage / Contract ir
� 1, qprml yrar Memh 1, airtent year
wha16 hi5 / her e%dCt share of inIC25t?
re m rernU is 6Rerent than Nat o! aOW��• �iqte bebw:
name at rrortgagee or mno-arl seue� // ��
( CX�
Atleress o( mortgagee w contraa uuer (numbe! an 4 dA: sfate, aM:
Name of assignee w other owner or hdder ot mortgage
y
AdCress o� assgnee (number arM svee; dfy, slate, and ZIP ootle)
Does eppticant oxn pioperty in any olher If yes, wtat munq?
l.�-1M E� , I� n�oN�
la-�a3
�
20
�
If ovmed
Page num0er
or eWrtaae owner!
❑ Yes ❑ No
h ihe W WeRY in Questim: MnuaDy P55essed
❑ R� Pro�ny ❑ am�y assessea
n+oa� � nc �i.
� //— '`/` /O
NRut Tawg D�stn�Y?
2q
Mas Na detlu�lion Eeen requestetl an propeny
ror werern Y��' r� ._ r-� .
20 I 20
infortnalirn is W e and cortect aritl Ihat Ne applicant is a resident o( I�iaria aM
ion is fiied.
Date (rtmfi. tlaY. Yae�
Date (rtronN. tlaY. Y��