HomeMy WebLinkAboutMortgage_Grigsby"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_ � FOR DEDUCTION FROM ASSESSED VALUATION���
Stata Fortn 93709 (R71 / 6-09)
� , PresaiGeC by DepartmeM of Local Govemmen� Firence
File Mark
srRUCnoNS: /� q
ro be filed in person w by maii with the CounryAuditw or Counry Recorder o/ the county wheieMfFeR�p9rry�� }�ted. F� ��:
Filing Dates: 1 J Real Property: Must file dunrg fAe year /w which the deduclion is swyht. ^,� Counry Auditnr
2) Mo6de /ManuFactured Homes not assessed as Real Propelfy Must file dunng tbeUir�9�l2J_rrwnfhs �� Recorder
before March 31 of each year the deduUion a sought `� � N
Seereversesideforadyi(ionalinsvuctbnsandqua�ificatbns. � GIBSONCniitirv„� __
istric[ � Key rwmber I legal tlescnD�+ � Reco�d num Pape numCel
-�s-i - �-od� � 367
f vdhc of proprlty I Ft��ape / Canbau'udebte0�ress unPaid as of gage / Contraa uNebteCness �mG� a of Is Ihe aVq�t Me sde
armla Mard� 7. airtent year date o( aPP��^ � w eduifable owneR
❑ Yes ❑ No
ro. wlat ¢ na 11rer e�tl share W interest?
�i-T��i.�'.L.'1
Name of rrongagee or mntrxt seller �/�
Pddress of rtnrtgagee w mntract sr�er (nuMer end sbeel, ', state, arrd ZIP code)
n oNer o�rrrer or
�2'CGS(3y ��N� p �2- �""'
�2E,v0� �o _
[
���
D�, 3 (�'1 �i
1/ We certlfy under Ne penalty of perj�ffy Nat Ihe above and f
amer I contra uyer ot the aforementioned property on da�
re (m� /s 3me) .
!
dent aEdr� d appGOnt um a sbee( tity, stdte, anC LP m
lo?/ 0 e u� / e 1.�
a� aww�aee er awr e.�cea aower or nvor�er o� ey ic s. i-i z-0 �
/ddmss of auMU2ed person (number aiM street, tlry, sfafe,
If owned wiN someone other Nan spouse, indirate with wlvn
W�at Tabrg D'avict?
COUNTYAUDROR
2a �
Is ihe WoDe+�Y in question: MnuaM As5e55e0
❑ Rea� Property ❑ amua�y nssessea
Has Nis AeEUUim Eeen requrstetl m property
far wrrent year?
❑ Yes ❑ No
� i Zo
I �"" � ��` I �� ".���_' I a -1 �--
in(ortnation is true and cortect arM Ihat the applinnt is a resident of IrMiana arW
ion is filed.
S
Date (rrrndi. daY. Y��
Date (monN. tlaY• Yea�