HomeMy WebLinkAboutMortgage_Elliott (9)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ ,, FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fortn 437091R11 / 6-09)
�' PresaibeC by Department of Local Govemmenl Frianca
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INSTRUCTIONS:
To be ned in �� N 1 �'"`�''
per5on w by mail wifh Ihe CountyAuditor or Counry Recorder o! the county whe2 the property is loca
F7'mg Dates: 1J Real PmpeRy: Must file dunrg the year for which the deduction is soughL Counry Auditnr
2) Mo6ile / Manufactured Homes rrot assessed as Real Property: Must fiie during the twelve (72) mont�s�.
before Ma�ch 37 of each year the deduction is sought Counry Recorder
See ieverse side foradditional instructions and qualilcations. GIBSON COUNTY AUDITOR
Au fownerdconfraGbuYer-sCeresUirlionsynmveisESitle) n
Psvssed �rWUe cQ reF
MarU 1. asrem y�r
tl no, whal
Key mimCer / legal desaiGtim / O Retord numCei Pege number /
�� -/ - z- yoo -000. ��-�-oa 7 oi a- 2��5
M�q�ge / Cantract Intle6tetl'ress unpaid az W Mort9a9e / ContrarY iMehteCness unpaid as ol is Ne aPWuant Ne sde
March 1, wrtent ynar Eate of apPGqtion legal or equiNade oM+reR
O D ❑ Yes ❑ No
interest? If owned wiN somearre aher n spouse, iMi�te with whom
s m reco�d's Ciflerent Nan that of apptirani, irMinte
m mmgayee « �,o-aa seue� 5 /.3
qddres o1 nwrt9agee w mntrad sWer (nrmiber and sveeL cEy, sta.e. eM ZIP cade)
Name ot assi�ee w o'Jier mmer w hoWer of matga9e
P,dCress of ass9nx um6ei aM stree4 �Y, �e. and ZIP cotle)
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Does apptimnt ovm property in any oNer If yes. what munry? NTet T.
��uv��i�a�aa � r, ..
Detluction appfovad'c�
20 _ � 20
Auditw
20 � 20
I/ We certify under the penalty of {y�jury that (e ove arW foregoing infortnalia
owner I contracl buyer ot the afwementioned erty on date application is fJed.
�� ne/s fW rmme)
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II 'tlent 'a.p^ t( mAer rM streef tlty, state, and ZIP e)
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autho�¢etl by duty ezecuted Power of Allvney or by IC Et.t-12-0.7
ICress of autha'ved person (num6er aM sbeeG dry, stafe. an0 ZIP code)
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Dare
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No
and