HomeMy WebLinkAboutMortgage_Barton (3).""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS T Year
_ FOR DEDUCTION FROM ASSESSED VALUATION ��
Slata Fortn 43709 (R70 H7-08)
`�.�. � Presai6atl by DepaNnent U Loml GovemmeM Firerce
wsrnucnoNS: JUL 6 �1�an�
To 6e fi/ed in person or 6y mad witl� Ure CaunfyAuditor d the camty wfrera fhe poperty is located.
Fili� Dates: 1) Real PropeAy: Musf file during the year for which tAe deduction is sought. �y�
2) Mobde /Manufarlured Horties not assessed es Real P�operty Musl file durrng tlre fweNe (12) maXR"s��fpreMekt1,31 0/ each year
the detluction is sought �� � �/
See reverae side !or a0d "4ional instrudions and qualfications GIBSON COUNTY AUDITOR
nooWam tm.nor or mnhacl W�- see iastrirlions m muerm vde� �
T;xmg Di
N (�
naessed
Ma� 7, �
ro.
�ma m
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Kay fwmhe�
ae-�
f real pope(ty as W I
Y� �
I har evatl share d iMerestt
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Contad'udehledneaunpaidasN MortgagelCorvraclinOc
irtaNyear dafeo(appf�tion
Name d mongagea or ca,iraG seoer �--1/�
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nddrass d morf8agee or mrtaa seuer (rumMJam s�mt ah: satG ano zm weo)
Name
a
�. avv�m ow�, v�+r �, ar�y ai,er
muMy in Indm�a7 � Yes
OeEuUion apprweE in iha amour�t d:
20 20 _
Sipnatura d cam+r nwnor
„,�,.�,�,
�
Y wrtred vrilh someona dher Ihan spouse. iMipte wiih whorn
num6er
Yes ❑ No
k Ihe MoGaM � GueSion: MnuaM Assessed
. - �Real PrapertY Q Mnualy A55e5sed
- ac�q...
pra���cr No.... ...
. ....
c:,��a �o. ...3�........
, �l�U,�.�v
N1NTY Al�u � un
20 _ 20 _
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Date lmanfh. day, yea�
a+mweM
� No
20
I/ We certify under the penaity af perjury that fhe abwe and faegoing u�fortnation is true and cmred and that Ne appficant is a resident a( InAia(u antl
owner I contract buyer of ihe a(orementioned qoperty on tlate ap0��� R filed.
(rum6a ad sbetl. �Y. abm.
person (nunbcrand5trtref,city,sbfo.andLPcode)