HomeMy WebLinkAboutMortgage_Mason (3)""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
__ _ FOR DEDUCTION FROM ASSESSED VALUATION
• S�te Fwm 43709 (R71 / 6-09)
, wr � Presvfbed 7Y �eP�kM of LDtal GovemmeM Fltunce
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INSTRUCTIONS:
Fwm Ned with�
To be filed in person or by mail with tha CounryAWitor or Counry Recorde� o/ Ne counry where the property is located. AU a
Filing Dates: 7) Real Property: Must file during the year for whifh the deduction is wught Q�{ry q�d��
2) Mo6ile / Manufadured Homes rwt assessed as Real PropeRy Must file dunng fhe hvelve (72J months
6etore March 31 0! each year Ne deduclion is soughL ❑ County Recorder
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See 2versa sidqfq adtlilional instrucUons arrd,qua�lficafi0ns. _ /f
MPrazm (a.
MmUt 1, Menl yW
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If M. Whel6 h6 / hE! Ci2CI Sh31B O( V11CR51?
If name on iemN's EiRerPnt than Nat ot appBqnt, rtMicate Eelmr.
Name of rtnrtgagee or mntraU seller
GIBSON
= aa3-D o/� s-o� � ao 9 P 3 �'�`�
act'vdebtedness unpaid a d Mortgage 1 Con;raC'uWebtetlnass unpaid as d Is ihe eppGrant the sole
�/�/�� data of av kgal or eQUitaNe oxneR
tSl l( /l/ I /n00� ❑ Y25 ❑ No
w mntraa seller (nunber erid sbae; ray, state,
sLeet �+N, state, antl LP code)
Ooe� a�imnt wm pmperty in any other I If y�s,
cwnry m �nciana? ❑ res
❑ No
20 20
AuOitot
I/ We certi undu pen
owner I mntract bu f tY
irawre (o ers name)
I revderit aderess w apprrant
COUNTY AUDROR
ttun spouse. uWimta with wlm�
IS C�e O�PertY in Questian: MnuaOy Assessetl
❑ Real Property ❑ MnUally �
Dra�ver \'O...oiRQ�..... .
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Caunry
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the above aM foregoing infortnalion is we and cortect and ihat the appGrant is a resident of Irttliana aM
property on date appliption is filed.
Date (month, day, yee�
(number antl shee4 tiry, sfate, an0 ZIP code)
or Ey IC
Adtlress of authoraeE person (numbe� aM sbee; ciry, stafe, antl
8