HomeMy WebLinkAboutMortgage_Rice (2)^�n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C To ' hi ear
__ _ FOR DEDUCTION FROM ASSESSED VALUATION �'�
• State Form 43709 (Rit / 6-09)
, wr Presaibetl OY �epartrtieN oi Lotal GovemmeM Fi�
oECF� ��u�u
wsrRUCnoNS:
Form Aed wmh:
To be filed in person w by maii wifh the CounryAUditw w Counry Recorder o( fhe oounry where the pmperty is located. .�
Fifirg Da[es: i) Real Pmperty: Musf file durnq the year Po� which fhe deduclion is soughG %C-�vl� Auditor
2J Mo6ile / Manufadured Homes not assessed as Real Property: Must fi/e during the tweNe (12J months �('-� �,�/��',,B�mr
before Malch 37 ofeach yserthe deduction is sought. GIBSON CO �L4di`/�FUD11(7Fi d�
See reverse side 7or additional insWCUons arM qualrfications. �
_. �=�=�8-� ao . ��� - - 0 �
Assessed vdue d real pfoperty as ot Martpag e/ Conbaa 4Ne6tetlness unpaid az W Mongage I ConVart indebtedness unpaid at d Is Me appl'xsnt the sde
Ma�d� 1, airail y'ar March 1 a� Eate of aOP����� �egal a equttade ovmeR
�O ❑ Yes ❑ No
tt ro. whal is his / her e�aU share of interrst? H owned wiN sameofre dher tlian sPO�. Gdipte �with wham
tt nane m ieard'a d}terent Nan that ot a7P��ti hWirate 6elovr. Is C�e property in Guestion: MnuaM Assessetl
� Real Roperty Q Nmually Assessed '''
Add2ss of nwrtgagce or mntrad seAer
Name af assignee a othn avmer m hdder W mortgxe
Mdress af assgnee (numhu antl slree4 �Y. smte. arM LP cotle)
Dces eppli�nt own property in any oNer
munry in Indaria?
❑ Yes
DeducUan approved in Ilre artwum of:
� �_
�a .ry .r r
I I we cerory Mer ihe pe alry ot
owner I contracl buyer of the afor
COUN
`^� �vI1Mt yPa(�
�
requrstetl m P��Y
_ ❑ Yes ❑ No
Dl•a►vet� NO,�qOlQ. : —
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above aM foregoing intortnation is We and cortect arM that Me applirant is a resident of IrWiana arW
�erry on date applicalion is filed.
Dala (rronth, daY. Y��
revEem addrass of appGmnt (numberantl sLeet, tiry, sfate, ard LP mtle)
�bOZ 5. Ma�n .�• �%� �ranL�.
Peison authoraeE Oy EWy exewced Pwer W Attaney or by IC G7.1-12-0.7
Pddress of authartrtd person (number and sLee4 ci�Y. s+ate, aM ZIP cde)
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