HomeMy WebLinkAboutMortgage_Watt"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_ + FOR DEDUCTION FROM ASSESSED VALUATION
• State Fortn 43709 (R71 / 6-09)
, Preutibed by Department ol Loral Govemment Fuance
�STRUCTIONS:
o be filed in rson or b mail wdh the Coun Audifor or Coun Remrder o/ the coun where !he Fc
Fdirg Dates: � Real Piopeily: Must file durirg Ne year for which the deduction is sought. ��m ���� Q C T 1
2) Mo6�7e / ManufaUUred Homes raf assessed as Real Property: Must fJe dunrg the hvefve (72) months
befae Ma�ch 31 o7each yearthe deducfion is sought.
C'J.
See reverse sitle /or addiUonal instrvctions erM quali�pfions.
Year
tpunty Auditnr
Counry Retorder
nppfrant rorcontracrbuye�-seerestrcbonsmreversesile) ' �/� GIBSONCOUNTYAUDITOR
• !��
7ap istrict Key numDer I legal d ' Remrtf number Pape numbu
a,6 - _ 03 -3oo_pD�f. 3 -D D �
As¢sed reNe d real poperty az d M1tortpage / Cantract irNe6tetlness unpaiA as N Mortgage / ConvaU irMe6tedness �npaid as d Is Ne eppOtani the sole
7, artW ymr March 1, wrtent year o aate of appfimtion legal ar eQUitade ameR
�� 5 7� ❑Yes ❑ No
tt ro. whal is ha / het ezad share at intelest? It ovmed wvh somewie other Ihan spouu. inAkate with rRarti
It rame m 2artl is Eitferent Nan ihat W applirant, mEinte Eelo�r. Is Ihe 7enY in GuesSon: MnuaDy Assessed
eal ProPertY ❑ Mnually 0.55essed
Name ai nprtpagea a mntrad se0er
Addr� W rtnm�a9eE w mntracc seDer (num6� end sLee; cdY• sbte, arN LP oode)
name m assgnea w omeJ owner w naaer rn rtprtgage
o� asvgnee �numoer arm suee4 �y. smie, ano ur cooe7
!.� SGJ 3-d-lo 3�00
�IifaN ovm property in any oNer If yes, whal munry?
Deductian app�wed in Itre artwnt of.
20 � 20
of
I/ We certify uMer �he penalry
owner I contracl buyer of the a'
Per'..on auNa¢ed M' OWY exewtetl
Address of auUrorrsed person (num
GOUNTYAUDROR
Distric[?
Dra�rer i\`0... ��� �
..
c��-� �vo. ....yy l.,�l
� �1�i���SZ........
20 20 _ 20 _ 20 20 _
Counry Date (rtia+W, daY. Y��)
the ve antl foreguing in(ortnaGOn is We and cortect arM that ihe applinnt is a resident ot IrWiana arM
prop rty on date application is filed.
p[q}ttiee4 tlry, statLe
/�C
dHttortiey w by IC
sveet. ciy, state, a
Date (rtronfi, d2Y. Yaa/)