HomeMy WebLinkAboutMortgage_Obermeier (3). STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS ,--_ Coun ,. Tavnshi Year
_, FOR DEDUCTION FROM ASSESSED VALUATION : �
State Fartn 43709 (R10 /77-08) �-
� y,. � Pfernbe0 by Departrnen� d Lad Govemmertl Firan� ' �i . ll,�./
�NSrnucnoNS: JUN ] Q ��Q�
To be filed in persan or by msd witli the CounfyAutlitor d fhe caunty where the property is located.
Filirg Dates: i) Real Property: Must lde during fhe yeer for which fhe deduction is sought.
2) Mobile / Manulactu�ed Homes not essessed as Reel Property: Musf file dunrrg tlie fweNe (12) mo�tths�6e�ar�� 310/ each year
fhe deducfion is sought.
Seeravarseside/craddAionalinstructionsandaualificatians GIBSON COUNTY AUDITOR
Appfiyaql (own� q mwxt euy,pr- see Rstrielais on io.e� sde) •
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u rema m raard is Qma(em uun tnat of apoucsrit. inaira0a oe�or.
Name d matgagea v mroaa se0er �
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Add�ess d mo�Ba9ee at coNract seCer (mn�be
Name d essig�ree w other owner p
Add�ess d ass9ree (�wnmor aM abeel. rdY. abb. and LP mde)
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B of appfimtion
i sameorre athat Uun s0ase.
�,reb a, d i: me ava� a» �
lagal or epulabk ameR
❑ Yes ❑ No
Is 1he P�rtY � Ouastion: Mnu
, Pal PrOperty Q /1flntal
Mobile
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Date (m�nth. daY• Y�I
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I/ We cu0fy unda the penalty of perjury Nat Ihe abmre and foregoily mformauon is W e arW owred and ihat the appicant is a 2sdeni of Ind"are anG
owner I m�trad buyer M Me aforementionetl {voperty on date applttation is filed.
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Persm aWhdrzeC by duly e�ma�leC
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reid sbce1, cily; abtr�, anELPcotlo)
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