HomeMy WebLinkAboutMortgage_Marvel^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS vear
,_, � FOR DEDUCTION FROM ASSESSED VALUATION
. �, State Form 43709 (R71 / 6-09)
�' ,�,� 1 PresaibeE by Departmertl of Local Goremment Fram.e
�asrRUCnoNS: NOV 1 �6i}a`i`
To 6e filed in person or by mail with the CountyAuditof or Counry Recortier o( the county whe�e [he pmperty is focated: � F� �� ���
Filirg Dates: 7J Real Pmperty: Must hle during the year /or which fhe deduclion is soughL Coun Auditnr
2) Mo6Re / Manufactured Homes rwf assessed as Real Property: Must file dunng the tweNe (72) months 7tnryri
6eforeMa�ch37oleachyrearNededuc0onissaght GIBSONCOU TY D uKReco�du
See reverse side fa addiLOnal instrucGOns erM quali�catans.
Aoo6mnl (ownerormntract 6uver- see resMCtiont on re�erse sia§I .. _ I
ssessed rdNe d rnal poperty a W
atW 1. amMi yPar
!q, Wh3t 4 h15 / hEf BiMi 5h2�E OI V
rurtie m remtl a ddfwart than that
mntrarl se0er
/
j=�'Ci�-cr�J,J i
ContraG intlebtedness unpaiE as o(
uitlicate Debw:
Aildress of nartgagee w mntract seller (number end shaet, ciry, sfate, aM ZIP code)
Name of assignee w oNer owner or holder N mort[
AAtlress of assgnee (numDer aM sbee4 �y. slate,
ryoperty in any oNer
❑ Yes ❑ No
De�uction appoved in 1tre artaunt of:
20 _ � 20 _
Signature d CamN Auditor
RecorE numbri Page numbe�
-Qa � 3
aqe / Conmact iMe6tedness unpaid az d Is Ne app(xa�t Me sale
�f eppGcation legal w epuitahle o�vne(?
❑ Yes ❑ No
1TEOf1C OfhBf Ihan SVW�SfJ. llldit3l8 Wl1h HRqT
6 tM property in QuesSOn: M`wa0y Assessed
�Real Roperty Q MnuallyAssessed
M1bbile Fiorne fIC 61.
Ib
ZlPootle) jO �O•'�• •. ` . —
pi;,,,����� .: ... ��5�' _
I( yes. wfiat munl7l� Whal Ta: • � ... ?erry
• � I
Cald��•....... •• _
COUNTYAUDROF � `�' " i'� � �
• '..�.-
20 20 20 20 20
I/ We certify under the penaly of perjury Ihai the above and (oregoing infortna�on is W e and correct arW ihat Ne applipni is a resident of I�iana aM
owner I contract buyer of Ne ataemenlioned property on date appliration is filed.
�
Pe�..on authomed by
� C/�--
dry, sfafe, ard LP code)
person (numberaMStreef,dty,sfate.andLPOOde)
Date (monN, day, yea�
I!-� �a01I
Date (rtronN. daY Yea�