HomeMy WebLinkAboutMortgage_Will (3)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__, s FOR DEDUCTION FROM ASSESSED VALUATION
� • Stata Fortn 43709 (Rt1 / 609)
S 1 p�y� py pe��M of Lod Govemment Finance
�� File Mark
STRUCTIONS:
To 6e filed in person or by mail with fhe CountyAUditor or Counry Recorder o/ fhe oounty where the property is located.
Fding Dates: 7) Real PmpeRy: Must �le dunrn� the year fi� which the deducLOn is saght. ry Audimr
2) Mobile / Manufectured Homes lrot assessed as Real Property Must file dunng the twelve (72) monfhs .�
6efore PAarch 31 of each year Ne deduUion is sought. n ecorder .
See reverse side Ior addtional instnrcUons arM qualfications. G I BSON COU NTY AU DITOR
AppfiraM ortantra`Y ,r�-/see mreverseside)
�y..� / /
Ta�d is' '_^/ , � m�+l�9�Qe�P�� RetofdnumCri Pagenu
(./ o- . � 9d - �a G/a o1�
u r._� o
ralue d mal O�W�Y as of MoRqa9e / Contraa 4debte0�ss unpaitl as of Mongaga I Con7aU iMebtedness �m7aid as d Is Ne aPG��i the sole
7, qpmnt ypr Marrh 1, wrtent yeer Eate of app�cation 7 j legal a equita6le owneR
G � ❑ Yes ❑ No
11 ro. what Is his / trer eraa share of intem3t? If awned wiN someo�re other Ihan spou.u. ild�icate with whan
If name df 2cnd is 6ftrlmt Nan Ihat of aVP�4 hfEica[e Oebvr. I5 Me ProOenY in Cueslim: MnuaDy 0.ssessed
Real Roperty ❑ %wlually 0.ss�d
0.bW'le Home pC 61.1-7
Nartre o� mori9a9ee or mnVari sGler �
Add2ss of nart9agee ar cmtrap seAer (nurtiber and sLee4 cdy. state. eM LP code)
Name of assignee or oNer owner or hdder of rtqrtgage
AGGress oi amgnee (number aM stree; dry, sfate. and ZIP cade)
�v oS - 3 -�/ /. �� 9e
Does appii�nt own property in any oNer If yes, what munty.� NTat Ta�dng Districl? Has Nis tletluoion Eeen requested m prapeny
counry in hM'ana? ❑ Yes ❑ No far artenl Y�n � Ye5 ❑ No
COUNTYAUDROR
Deduction apprwed in ihe amount of.
20 _ 20 _ 20 20 _ . �n . — �n. _ _ —_ ?Q —
�����,a,�� �« Di�a�� er \O. �QI.�.........
I/ We certify under the penalry of perjury that the above anC foregoing infomatic °10 Q ' �iana a^d
owner I contrad buyer of the atoremeMioned property on ate application is filec C Z�� ��r O O( v
Siprehue e/s MI ) ��.2 (� _ b W 5 li �t_.�/. �j
�7 �2i1J7
�I ent aEdrea of app�rant (number antl sheet GN. �te, LP mtle) _� �'G �y
io3 �s' s. a90 �. Ff B� h� ti,
Person autlroraed Dy tlury exewted Power of AttorneY a M IC G7.1-12-0.7 Oate (monlh, tlaY. Y��
Aqdress of authoraed per'..a� (num6er aM siree; tiry. stale, an0 ZIP oode) .