HomeMy WebLinkAboutMortgage_Gardner°"'� STATEMENT OF A110 AGE OR CONTRACT INDEBTEDNESS Coun Township vear
FOR DEDUCTION FRO SED VALU N
State Fam d3709 (R70 /N-08)
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MSTRUC710NS: FI M
To be filetl in person w by mad witlr the CountyAuditoi o/ the oounty wheie the property is lacaled.
Filiig Dates: i) Reel PropeAy: Must file Uun�g the year Ior which the deduction is sought. 1,�,�v
2) Mo6de / Manulectrnetl Homes not assessed as Real Property: Must file dunrg Ihe tweNe (12J mmfhs befar�Nfdrth � qte��e�
thB deCuction is sought
See reverse side for addCional inshudions and 4✓�lificaticns
App wnaor cmRiad Wryar- sao m re ")
GIBSON COUNTY Btfids
T' ' Key r/lepaldaspiption � Recordnumber Pagefwmber
Q ca' --- ao _ ao/ �//- oa 7 �� 0.3�
Asasmd value d�aal properry as d Mortpage / Cartliad "cde6ledriess unpaid as d Malpaga / Con4aG inEebledness un�eid a5 d Is lhe appGraN O�e mla
MaRh 1, a�rteN yea A/amh 1. aureM year
' 60.
H ro. what is his / �m esarl shara of iNerest7
M iama m iemrd is Q�afenl than Ihat of a7o�l'vdim� Calar.
Name 0� mutgag9e or ca�rtrt�aU Seoer /
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Addrass d`mroapee a caGrad se0er ( rand
Name d essigrree or o9�er wmer a hdder o
Pddress d assignee (iwrttlrc and sbeeG �Y
Does app&anl am yaparly in a�ry alher
Dedurlian apPrweC in tha amourtl of:
zo o `7 1 20
I/ We certify uMer the penaly of p
awner I mntracY buyer of fhe aforei
�ate, ard
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tl owne0
�Fu0 resident addfass d aPP�icani (mm6ersM sbnw. riA: aTa�-aoC.21P rn0o)
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Persnn a�nhoraeO by Cuy azeaimE Power d Ammey or by IC 61.1-12-0 ]
AOEress d author¢ed persan (n�mbrJ arW s4eef, dty, smlo. and LP mde)
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P�ODBM YI GU@SUIXI: M11WM ASSBSSB4
3al ProPertY ❑ MnualyAssessed
Mahiie Home (IC 61.
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