HomeMy WebLinkAboutMortgage_Callis (3)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
s FOR DEDUCTION FROM ASSESSED VALUATION
� Stafe Fom d3709 (R71 / 6-09) �
�' � Presaibed 6y DepaNncrd of Local GwemmeM Fuance
il Mark
INSTRUCTIONS:
To be lled in FOfmn�-� �'
person or by mail with the CountyAuditor or Counry RecoNer oI Ne oounry wAere tAe property is Iocated.D E C 2 p-�L U�U ry
Fil'mg Dates: i) Real Pmperty: Must file dunng the year /or which Ne deduclion is soughG U un Auditnr
2J Mo6Ae /Manufeuuled Homes not assessed as Real Property Must fiie during the tweNe (12) months
before March 37 of each year the deductiar is sought. ❑ County Recorder
See reverse side /or additional insLuctions arM qualilrcations. ��' �
AppGrant(oy7�armntrarlbuyer-seerestric6onsmre.erse�{ie) • GIBSON COUNTY AUDITOR
Tab�g Oistrirl Key numher / legal desai0� Recortl numCer Page number
a�-i9-i�-3�3-o00. ��a-oa� ao�o a3Yl
A�essed vdhie d2al property az d Mortgage / Contraa indrbtedn¢s unpaid as d Mortgage / Contrart i�Wehtedness unpaid as of Is Ihe eppGont Ne sole
Ma�tl� 1. anvtt year Mart�h 1. wrtant year date af appGcation kgal a eQui�a6�e a�mrYl
as o00 ❑Y� ❑N�
tt ro, what fs his! her e�c[ share of interestT If avmetl wdh �e oNer ihan spouse, iMkate with vArorn
If name m 2md's EiReren[ fhan Nat of appOCanl, mdintc hebw. � y�¢ prppPRy in O�a�: �nua0y Assessed
❑ Real ProPertY ❑ !4rm!!all�! A�ssed
w mntraU se9er (n'urib�v entl sbeeG �1: state.
owner w MWer oi mortga9e
AdCress of asvgnee (numberaM stree; dry, state, erd LP oode)
�,-2t�r-(i Q�-� �f ��
Oces epptiCaM own D�PenY in aM dhG I( yes. �Mfat mum7R WAat Tarirg DistritY? Has N's deductia� Deen 29uested m P�Y I
munry in IMana? ❑ Yes ❑ No ��� �r ❑ Yes ❑ No
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