HomeMy WebLinkAboutMortgage_Parks^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
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FOR DEDUCTION FROM ASSESSED VALUATION
� State Fortn 43709 (R77 / 6-09)
��.,. P�esai6eE G/ DepartmeM o( Lval Gwemmerd Flrence
�JSTRUCT70NS: -
To be filed in person or 6y mail with the CounryAuditor or Counry Recorder of the oounry where the property is located.
Filing Dates: 1) Real Property: Musf file dunrg the year /or which the deductlon is waghf.
2) Mobde / Manu7acNreAHomes rat assessed as Real Property Musf Ae dunng the fwelve (72) months F
before March 31 of each year the deduction is saght.
C
See reverse side for additional instructions aIM qualifications.
GIBSON COUNTY
ZSoanry Auditor
U I[
Counry Remder
Distria Key rnan6er / legal desrnp' Remrd num6rl Page numDer
R�-o.m-✓ - a a- l - 3 0 0- o o r�, a 3 9-b � � d'
ed vah�e af rcal popaty as d Mwtgage / Contract intleb[ed�ress unpaid az d Martgage / Cantraa uWebtetlness unpaid as d Is tlie appGfant Ue sde
I, amem year MarM 7, artent yeer Eate of aOP���+ kga� w epuitade owne(.+
❑ Yes ❑ No
hat a his / her e�ct share of interest? If ovmed MiN so other Ihan spouse, iMicate with wt�mn
It na�ria m
Name of rtprigagee or contract SeUer
Address of rtnrtgagee w mnbaa seAer (number and sbeet, ciry, sfate, aid ZlP code)
or oNer owner w halder of mortgage
state,
Oces applicaN am WnpeM1y in any aher
wunry in IMana? ❑ Y�
❑ No
D�fuc9on approved in Ma artaunt of:
zo _ � zo
�
a.�� f
If yes. what munty? NTa� Tadng Distru
COUNTYAUDROR
zo 20 2c
se�awmwf�amaab�m, �i'�2.��Y�
I I We certify u�Ne penalry of perj Nat the
owner/ mntract buyer of ihe aforementioned pro
Counry
peny in VuesUm: MnuaM Assessed
RopertY QPnnuallyASSesSed
�
? Has Nis detlWion Eeen raGUesteE m pmperty
_' - tor arrent yean
-' _. ❑ Yes ❑ No
P/-1 �eKS'� S7ua-,e� E
�%! y f�
/�2 _ � 9 g
nd toregoing infortnalion is W e and correG arM Nat Ne applicant is a reswem o� �.....__
date appfication is filed.
Qate (imYh. deY• Yuar)
appfmant (number antl t, ary, state, and
30o S ' �BS%/t�0
dy executed Power of Attomey a by IC Gl.t�
Pddress of a Ww�sed person (number aM sneeL ctiy. sfafe. arM LP m0e)
Date (rmnh. daY Y��