HomeMy WebLinkAboutMortgage_Stallings"'� STATEMENT OF MORTGAGE OR CONTRACT INDE S C un 7ownship vear
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; FOR DEDUCTION FROM ASSESSED VALUATION ��
Sta[e Fortn 43709 (R71 / 6-09)
�,«. � P�esaibetl by DePartment of Local Govemmenl flnance
JAN 3 0 2012 File Mark
NSTRUCTIONS:
k be filed in FO� ��'
person of by mai/ with the CountyAUditor or Counfy RecoNer of the county whe/e"thfl�prtip���� ted.
Fdmg Dates: i) Real Pmperty Must file during fhe year for which Ne deduction is sought l C'��" n Auditor
2J Mo6ile / ManufacNied Homes not assessed as Real Property.� Must file dunng fhe hvefve (?� niencns ry
beforeMarch37oleachyearthedeductionissought GIBSONCOUNTYAUDITOR �nryRecwder
See reverse side tor adddional ins(ructions and qualifications.
AppGram (o�mer � mnf(aa buyzr - see reftfc0ons m reve - si7e) _„ �
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Mamh 1, arrem yrar
4- �,C�li�-� �c.� � �
�er / legal desaiption
- �-ol-►a�-6o�.oa-7-o
MoRqage / ContracY iMebtedness unpaid as of Mw
Mertii 1, wrtent year 4atE
I( no. what is ha / Mr erad share ol interest? -—
If nartre m recad "a Eirterent Nan that oi aOP��t mdipte below:
Name of rtqrtgagee or crno-act se�er
Pddress o! matgagee or contract seller (number aM sbee4 cM. �re. aM
Name o( assignee w aher owner or halder of mortgage
Pdtlress of assgnee (number and sfree4 �y. slate, aM Z/P code)
Oaes appinm o«n praperty in any dher If yes, what munry
�� �� ����
❑v� ❑No
�
Drductim aPV� in ihe amount of:
zo � �
ReCO�d nimber Page numCer
a o% ��
indeMedness unpaiE az d Is Me app6tant the sde
legal w eQuitaWe ameR
❑ Yes ❑ No
�h q�h�e �D,ro,P�Y in queSGDn: MnuaDY Asses.ed
uT^•��PeI�' ❑AfIttU211yASSC55Ed
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Na
I I We certify under Ne penalry of perjury that the above and foregoing in(ortnation is true and cortect arM Nat uie applica�„ . .�n ui intliana aM
ovmer I contracl buyer of the a(orementioned property on date application is filetl.
�naWre wtcehlWlreme) Date(rtioriM,day,yea�
i�;.`��►� � ; ,�. .�n��� i - 30- , a
FWI �SWentdCtlresS Of applitant (wm66��TG SY8e4 dty. slate. an
i I 1 l'� '� 1�O N V��—� �-,�
Persm aut�a1rsed by AWy ese1vte0 Power W Attorney rn by IC Gt.
Pddr�s of author'veE per:nn (numGer a� sbee4 tlry, sbte, anO LP wtle)
Dace (monM. OaY. Y'��