HomeMy WebLinkAboutMortgage_Pickens°^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS n Tow Year
_. FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fam 43709 (R10 /77-0e)
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INSTRUCTIONS: F a
To 6e filed in persan or 6y mad wilh Ure CourdyAuditor of the county wheie Ne property is located.
FJing Dates: iJ Real PropeAy Must file during the yeai tw which the deduction is soughf. `�� � /!
2) Mo6de/ManWSCLi nd assesse0 as Reel Property: Must file dur'ug fhe7weNe (12J mmUu b�arffAie�rcv�v� � ch yea�
fhe dedt�ction is t.
Seereversestlaforadd"dio endaualifications GIBSON COUNTY AUDITOR
o��0•�,3 -O �-
e�nem�vw�y�w n��¢a� �ma
7. aarent yBa Ma�ch 7,
tl ro. Wat 5 hb / �m e�tatl share d i�rasl7
If �me on �emrd is diHefam Ihan Uul of zOV�. udira0e bebv.
Narna d rtiarigagw or mMrscl seller �
amre:s d mon¢age� «canr�aa seoer (m.,�be�aro sWec �r. �. �+
NamB d a55igrree or oihm avner tt holder d malpage
Pddresa af aa9nee (�wrMa and sNxG NY. s6b. ad LP oode)
m�uMyam�IM�'na��? ��M in arry dhar M yes. Miat cau�M
❑ Yes ❑ No
Deductian appmved in tl�e amount d:
20 20 20
/ �
OD /. !c SY- o
as d Matoaae / CWrad ind�
If wmed wilh saneorre olher Ilwn sGWSe.
couNrvauwroR
20 _ � 20
Ca�mry
o a ��
�npaid u or �s me zcd:�m u�e wla
legal or epuitabla owne/�
❑ Yes ❑ No
Is Na pmpa�ly in 9uesiion: AnnuaOy Assessed
�RealPropeAy QMnuallyPssessed
Mo6ile Hame fIC 6
�?2C W�,�= ` - -- _
�,� �'s m
�'-�.�,�� -
20 _
�ate (monN. day.Yra7
I/ We certify under � penalty af perjury t��f Me above arM foregoing information is true and cwre� antl fhat the appiicant is a resitlent of Ind"una aM
amer! mntract 6uyer of ihe atoremenla�d qoperty on date applintion is filed.
mawre (o.+rer: nm,w,ne� �. n oate Qnonrn. ear. r�
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