HomeMy WebLinkAboutMortgage_Warren (2)'°� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Courc
.;,__ ; FOR DEDUCTION FROM ASSESSED VALUATION
Slate form 93709 (R71 / 6-09)
S 1 Presoibetl by DePartment ot L«al Covemmenl Flrence
�STRUCT70NS:
6e filed in person or by mail with the CountyAuditw or Counry RecoNer of the county where the pmperry is located.
F�7ing Dates: 7J Real Propeiry: Must file dunng fhe }rear lor which the deductlon is sought.
2� Mo6de / Manufacturcd Homes not asseszed as Real Pmperty Must fiie dunrg the tweNe (12) months
before Maich 37 of each year the deductron is sought.
See 2verse side !or additional inst�uclbns arrd quali�ications.
Aoofirantfrumnrmm�trarl6irver-seereshi^lioner»rvwr.mc'rlrl J
As�sed rahre drnal popa;y as d
Mamh 1, pmpn� year
tt no, wha[ is ha ! her exact share of interest?
r�aldesaiption
_ i a,
wrtent year
Ii rume m �emtl is diPemnt Nan Nai ot app6mnt, uMZate Eebw.
Name of mongagee or mntract seller /� � , �
(J �(�i
Mdress W rtongag� or mntrad se0er (n�ni6er and sfree; ciry, state.
Name of asvgnee or oNer owner or hdder d�mrtgaye
A�Cress of asvgnee (number a� sdee4 �rti: s�ale. and Z/P wde)
�T � .sE I�-a -ro
Oces appl�m van prapeM1y in arry oNer If yes. what munty?
Year
�ry Auditor
County Recorder
GIBSON COUNTY
0 5 0- o a� Remd numbu Page numbri
- 400 -o�d�. oc�-( �(�o�
eEness unpaid as W PAOrtgage / Contrac[ mde unpaiE as d Is Ne eppGrant tlre sde
tlate of applKation l, Iegai w equrtade o-mreP
� Q� �/ ❑ Yes ❑ No
if owned wiM someona dher than spouse, ifMicate wdh wMm
Is the properry in questim: Mnuapy A1sessed
[�Real PropertY Q Pnnually0.SSes5ed
zo i zo i zo i zo
o s s� �
What Taurg Dist�M?
II/ We certi(y under the penalty of perjffry Nat the abrfbe and (oregoing information is true
owner I mntract buyer of the afwemerttioned property on date applicalion is fileG.
�ISlgnaNre ( %s fiA name)
� � _ % i . _ J�� //l.ii . _ _ �
state,
Pelson autM'aed Ey d�ly ezecutetl Poxer d Attorriey rn by IC Gt. t-72-0.7
Pdtlress of author¢cN person (number aM stree4 tlty. sfafe. and LPmAe)
Has Ihis tletl�xfion Eeen re9uestetl m property
��� ❑ Yes ❑ No
Drawer NO..'?:�..°.�."....
Card NO.....�b:s�......
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