HomeMy WebLinkAboutMortgage_Williamson (3)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
_,_ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (R71 / 6-09)
�,w � Presvibetl b�l DePartmertl of Loral Govemmerd Flrenrs
INSTRUCiIONS:
To be fited in person w by maii with the Counry Audifw w Counry Recorder o! fhe county where the property is located.
Filing Dates: 7J Real Property: Must file durirg fhe }rear for which Ne deduction is sought.
2) Mo6i7e / ManufecN2d Homes �rot assessed as Real Pmperty M`csf file during the tweNe (72) months A �
6efpe March 31 of each yeai the deduction is spgh[.
See reverse side for addilional instnictbns and qualifications.
AppGCant or mitract b'�j �" m re.erx side)
. n /��_J �/ i�piA GIBSON
As�sai rahe aF rPal pfapttty as o!
A1ardi 1, aRVn yrar
If ro� what is Ns / hu end share a�,
m
Nartre ol mortBaBea «oontrarl se0er
Mdrea of nnrtga9� u contrad se�
Name W assignee or ahel ovmer w Y
ry rwmEer / kgal desaiPtion
a�'-�4-�9 -
of a0P�4 trMirata hebw
dicant v.m praperty in any oNer
Ind"ena? ❑ Yes
oeauccon aawcVee h me artn,nt or.
�_
Si9�nae N Counb niWitor
� I/ We certify urder th�
" owner / mntrac% buy�
� sig (owrief:luerem
. FWreside�rta0tlressdaoo
•��
sfraet �Y. ��.
_oo o. 9 a �- o �
slete, eiM LP oode) �
If yes. whal muntyt
I No
File
�Co lari Auditur
CU ll"
County Reoorder
Record number Page number
0��7 37
unpaid ag o! Is t�e eppfiwfl Ne sale
kgal a equitade owner?
n Yes ❑ No
If ownetl with sommrie otlmr tl�an spouse. udifate wtth
couNrrauoROR
� i zo
Pivperty ❑MrnWh�Aa�s�
Moble Home (IC b
� ��
��triU7 Has Mis dedumon Deen f Wuested m D�Y
for arteM Yea(t
❑_Y� _o_N..—
� 1�:0� l, l�J �'�-liv�sDF-)
1_ . �
p— d��o �� � � g
/n� Counry
'-1 /J OfA - _
nalry of perjury Ma e above aM foregoing infomiation is true and correa and that the apptirant is a residerrt of Ird'�ana aM
ot the aforementione property on date appfication is filed.
i ' .
Date (r+a+fh. daY Y�A
steet
amsa� a,u,�a ey a�er eYew:ea a� wnn«ner ��y �c s�.�-�z-0.�
P4tlras of autl�d De�"� (n�mbe�ard sneeS uN• �, aM LP mde)
8
Date (rrunN. d�: Yea�