HomeMy WebLinkAboutMortgage_Nunez-SalemieX
STATEMENT OF MORTGAGE OR CONTRACTINDEBTEDNESS Year
� FOR DEDUCTION FROM ASSESSED VALUATION J
State Form 43709 (R10 /11-08j "
� � Prascribed bY �Vartrtren� d Lmal Govemmertl Firunce
INSTRUCTIONS: Fle Mark
To be fded in person or 6y med witli the County Auditar d fhe county wfreie Ute poperly is located. �
Nlirg Dates: iJ Real Properly: Must file dwing the yeer for which the deductron is saught. `"�7
2) Mobde /Manulactrnad Homes nof assesse0 as Real Pro{rerty: Musf file durnq tl,e lweNe (12) monUuGefo%"��erch 31 e r
Ne deducfion is sought
See ievarse side !cv addAbnal insWdions aM qualificatians
GIgSON COUNTY AUDIT �
Mv�^ (awnerarmrwaclWA'�-�e mlevaraeside) 7 .
/ �/l/�/Y/iu%dii Lilf'....�/ `�l/._.._/-) � �OivMt/ i
— ,`Y � ,X _
aaessea vaue a�� prapany es a� i t:omrm� o
Ala�ch 1, mrent yea 1, w(rt�eM year
tlro.whalisha/�ere�sharedi�rast? � " �
M(ume an recutl is d�erer�t lhan ihat o( app6ranl.'uNY
Name d ma�igagea or cantraU seller �
�
Pdtlress d mortgagee or fmirad se0er (wnbe� antl aG
Name d assigrree or oiher ownar a hdder d morigape
Address d assgnee (wrsCr� and sbeeL �Y• sfate. aM
Does aPpG�nl own property in arry alher
counry m IMiare9
❑ Yes ❑ No
Dedudian a0vroved in Me amourtl d:
,�ij�sz��
-r��o" 9�8-Oa
as
date
If wmed wiih someone other ihan sPOUSe,
ceC �Y• .T�. md ZIP roeo) .
LP cado)
If yes, vhat toulm'4 Whal Taz'v
COUNTY AUDITOR
F4����
� aDP�M It�B sala
n epuhabla awneR
❑ Yes ❑ No
� �e a�weM � auesfian: nrnua�rwase�a
❑ Real Pmparty ❑ MnuaOyAssessed
MoGile Hortie (IC 6
Drawer NO...�2..�.9,,,,,,,,.
Card NO. ....°'�.��Q.........
, �'W, 3gS . =
— � � '—
I/ We cerlify under the penalry of perjury that the above and foregang 'vmfmnation is We and correG and that Ne applicant is a resi�ent of Ind"a� anC
owner / mntrad buyer of the aforementio�ed {xoperty on date application is filed.
�natytg(owrreYs/�name) �� n. Date(mmN.daY.Y'�)
a�„��s_,,,2-0�
Pddrass d aultmzed parson (nvn6er antlsMOef, tlty, sbte,
5r76 5�6"=