HomeMy WebLinkAboutMortgage_Hartig," STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou owns p
_, FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fam 43709 (R70 /17-08)
� yw � P(ascnbed bY �Vartrnent d Lo� GwemmeN Finance
INSTRUCTIONS: 10 a J
To be filed in persan or by mad witlr the Coun(yAuditar d fhe county where the property is locafed.
Filing Dates: i) Real Propeny: Must fde during the year /or whicA the deduction is saighL �
2) Mobde / Manu/ectured Homes not assesse0 as Real Property: Musf file tlunrq tl,e (weNe (12) mmths be/ae Mar�t 10/ e yoar
fhe deductron is sought
GIBSON COU�TY AUDITOR
See ieverse sOe !or addRionat instru�iorts and quakfications '
7azi� Distrid Key munher/ bon
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ASSBS�dY�tiBO(fB31FfOpBflY890( MIX(�3QB/COf1l13difIdObll
AfaRh 1. ameN yaa Maich 1 year
H ro. wtut is h¢ / her esaC sh5re d i�tasY!
C reme m �ewd is Q�e(em than that ot apptiraN,'vdimm Oelwc
Name d matgagee or cantrea saber /,� ���
( (J
Addrau d rtort9� w mrtrad se0er (nunberand sGcet ml: sbte, and L
Name a assgtree m aner rnmer a Mlam ot matgage
Address d�ignee (num6e! and SLf:e; cAy, smte, aW ZIP oDEO)
Does appGwnt am PopartY in a(ry dhar 7 yes. rAc
m�ny �o iro�g�s r-+ - - ^ - �
DeEurlion aC7roved in rtie art�our�t d:
20 _ � 20 � 20 _
I! We certify undel the penalf
er / mntrad f Ne �
� ture"�D�puYshCl nre)� �
L
� Persm aulha¢ed by duly azeai0ed
nderess d aulnaized aersm (num
Ihat the
v ny
�d -ODV. 1S3-o�Z ��� aoo'8 � °yj��9
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dale of app(�tion legal ar epu3abia owne?
�oa a— ❑Y� ❑No
H wvh someo�re alher Uun aGWSa. indrate wM whan
6 me p�operty in a��: aimrah wssessea
❑ Reai Propa�ty Q Mnually Pssessed
Mohik Harte fIC G7.1-7
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caunry9 NRiat Taxing Di
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couNn nuaroR
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20 _ Zu _ zu _ 20 _
CwNY D�6 (mor�}14 �: Y�)
fwegoifg mformation is true and cwred and that the appOcant is a(esident of IMia� aM
tlate applircation is fi�00.
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