HomeMy WebLinkAboutMortgage_Gipson (2)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fortn 43709 (R71 / 6W )
� wr PrrsaiEetl q' Oe7a�M of Laml Govemmerit Finance
INSTRUCTIONS: �
To be fifed in person a by mai! wiN the Counry Autlitor or Counry Recorder of the counry where the property is located.
FrSng Dates: 7) Real Property: Must file dunrg the year lor which the deduction is sought.
2) Mo6Be / Manufactu2d Homes rpt assessed as Real Pr[ipeerty Must Ae dunng the fwelve (12J months
before March 37 of each year the deduction is sought.
See reverse sitle for additbnal insfi�clions arrd qual�ications.
MVG�9�ortontraGbuyn�-seeresfri�onsmreversesiiSY� s
i� � c�co- v- - uu-
A�xssB reAedreal eryasol A�� /Cantraain e6tNnessi
lAazU11, a�l yPar Marrh 9ea�rmnt year
Ii m. what � ha I her exaa shaie ot intelest?
If narte m remtl is OMeratl M2n that ot a0p0Unt, 4Mifate bebw:
Me2ss a m[vtgage� w mntract se�er (numoe� ar
Name af assipiee or oNer avmer w hdder W mortc
AdEress W astignce (numbe� and sCeet �Y. state.
Does applrcarrt own poperty in any other
muntv in IMana? � .–.
r1ly, sfate. aritl
�
iu , .. orco - c�o�i
a� as d Morigage / Con•vari mEetr
date of ap
tt avmed with sarneorie atfws tl�an s�
I�
�
-�_/.� � �
��
� I ❑ Yes ❑ No
xse. htlicate wiM wirom
�e P�GertY in Ouestion: MtwaOy Assessed
Real Property � MIIIUaIIyAssesSed
e
Has Ih6 deductim Deen re9uesleE m prapelty
��tl� ❑ Yes ❑ NO
GOUNTY AUDROR _� �
ducum appfwM N Cre amount oF. — p
� �_ p— �— n G,J's�''► �� ,�-
����,�� ��h �d� p,a o3 �I
. I I We certfy uMer Ne penalty of perjury that Ne above arW faregoing infortna�on is true and c
owner � contract buyer of the aforemen�oned property on date appl'xation is fiied.
Sig (a�xierSfiAname)
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F revEent d a (num6er and shee4 �; s7ate, and ZIP codeJ
� 4G! W, YSo �W�r�s :11 �N y 7GGS'
Person aulhor2ed Dy 01dy exeWted Power of Ait�rtiey w by IC 61.t-t2�.7 ��
ACdr� of auCmr'ved person (number aM sbee; �y, sfate, aM LP cntle) .
..eu� lmonN. deY• Y��)
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