HomeMy WebLinkAboutMortgage_BealSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
FOR DEDUCTION FROM ASSESSED VALUATION
S1ata Farm 43709 (R10 /17-08)
� � Pfawibad by DePHrtrnenl W Lod GovemmeM Finanm
INSTRUC710NS: �e a �
To 6e filetl in person or 6y mad wi(h the CouNyAuditar d the county wfrere the poperly is IocateC.
Flirtg Dates: 1) Real Property Must fte during the year for which the deduGbon is sovghf. �I ���� 1 p ��(7p
2) Mo6ile / ManuleWneC Homes nof essessed as Real Pioperty: Must file tlunrn� fhe twefve (12) monfhs DOfatl' M&ch�31.bF'd6ch year
fhe deduction is sought
See rev�side foradditional insWdions alW 9ualifications. "7» /1!!..
�1�.1�1/lti GIBSON COUNTY AUUiivrs
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Assessed value draal praperty as d e/ iNe6ledrress �mPa�d as N Mongapa / CorRrad indebtedness �m0aid as d Is lha �P��b Na sda
Mam,l� i. amaN year . Y /� `�, dale of appG�ation legal OuAable owre(t
JvtJ ❑ No
N ro. whal p ha / he� aratl share d i�res!! �f wmed with someone dher than spouse. indirate wifi wfian
H rama m rem�d is ddfarard Ihan IFut o( aPV���. indimfe bebvr.
Name d matgagee ar conlreci seller
moitgagee or
nGdress d asignee (numbor and:
Does applirant am poparty in a�ry
caunN in InQta(u7 r-� ..
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1/ We cerlify un0� N� penalty ot perjury at the above antl foregoing tr�formalion is We and correU an
owner I mntrarl buye of ihe aforemen o property on date apptintbn is filed.
�^nature (avrvYs fiEl rume)
N
II resident address d aPd� er and sboot. ciy: ata -. and LP code)
° 10 s� Fos �P_ r FF B rct,�.c� � n/ �1� 6�(�
rson auU�waeE by duly execvteA Power dAlbmey or by IC 6-1.7-72-0.7
Is tha G��M in ques�ion: MnuaN' Assassed
�RealProperty ❑,4nnualyAssessea
I�
� .a7-o�
(month. daY. Y�)
ry
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