HomeMy WebLinkAboutMortgage_Thomas (5)_^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE� un iP Year
FOR DEDUCTION FROM ASSESSED VALUATION
. � Stafe Farm 43709 (R71 / 609)
,,,,. Presrn'betl by Depanmard o( Local GovemmeM Firence
uurnucnoNS: SEP 1 0 ZD�e�`�`
Fortn Ned wiN:
To 6e fiied in person a by mail with the CountyAUditor or Counry RecoNer o( the counry where the pmperry is located.
Fitag Da[es: i) Real Property: Must file durirg the year fiu which the deduction is soughL ,(� � County Auditor
2) Mo6de /Manulaclured Homes rat assessed as Real Property: Must Ae dunng the nveNe (1 if ' G� ��ry R��
6efore March 31 ofeach yearthe deduction is saqht GIBSON COUNTY U i R
See reverse side for additional instrtrctions and qualfica[ions.
Apqfyant (owr� u contrart buy� - see re��s m rawrse siYe) 4' .� . ._
-09�-3od -voo. S 99-o a7
;e ! Contrarl irdnbtedness unpai0 as a( Mortgaga / Con7aa vMeM
I( no. whal Is ha I her Pxar2 share Of intere5l?
If riame on �cord a Eitfe2nt Nan Ihat of app�cant,
Nartre of mM8a9ea ot mntrarl seller �/ �
Address of �ee or conbed se0er (n�mbrl and stree; crty. sbre, eM i
Name af assi�re w Wm1 ovmM w holder d morcgaga
AAGress of assi�yim (num6ei aM saee4 �. smte. end oode)
�7 N� sa�
Does applitant own pmpnity in anY �� If yes. whet wunC/.+
�^q'�^i�am�? n .,_ n .�_
F�'�7
� I/We�
axmerl
r�
amount oF.
'��
20
someone other ihan spouse.
R¢my numbc Paga num0a
O1a 2-$
�,��� u���t��
legal a equitade ow�re(t
❑ Yes ❑ No
�d'xate wiCi whom
perty in puestim: Mnually Assessed
RoPertY ❑ M�uaM Asse�ed . _ '
- � -�o .03� �4 �-
Wlut Ta�d'g D'atricl7 Has Nu d�n Deen reGUesteO on P��Y
tor arrera YwI' ❑ Yes ❑ �
� N /�M I �nry
Ne penalty oi perj Mat Ihe above arW foregoing infortnaGOn is W e a
yer of the afaemenboned property o� date application is filed.
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- ' ....,ti�� �� oi uwiana aM
Person aWnraed Dy duty exewced Powe+o( MtameY a M IC F7.1-i 2-0.7 ' ' I�(��. �Y•
Pdd2ss af authorrzed prlsan (number antl sneet, dry, sbta. an0 LP mde) _