HomeMy WebLinkAboutMortgage_Harder"`� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
__ = FOR DEDUCTION FROM ASSESSED VALUATION
• . . • State Form 43709 (R71 / 6-09)
,,,,, � Prewi6ed by DepartmeM o1 Lotal GovemmeN Fiiwica
wsrRUCnoNS: MAR O 2 F�e�ar�
To 6e tled in person or by mail wHh the CountyAud'ROr or Counry Recorder of the counry where the property is bcat Form laed w'n''
Filirg Dates: 1J Real Pmperty: Must file dunng fhe year h� which fhe deduction is soughL �' �• Coun Auditnr
2) Mobde / Manufactured Hanes not assessed as Real Property Must file during Me twelve (12) monfhs _ ry
before March 37 ot each year the deduction is mught. nN Remrder
GIBSON COU T DI �iZ
See reverse side (or addit"qnal instructions and qualifications. '
aring Distrat �" Key numbel / leg
a� -/ �
�� �r�o� , ��r A1or�q
Ma�U 1. wmLL ymr A1am3
If m, what fs Itis I her esaG share of inierest?
If rwne on �amd is Eifiefent Nan ihat of applkan; irWk
Name of rtnnpagee or tontrarl seller
�
Pddress ot rtnrtgagee ar contrad se�er (nurtibrl
Name W asdgnee or other owner w holder W mortgage
naaress
� a�� �„ �� � a�Y
��uy �� i�a�,aa r-� ..
.S—���'D�.3.
e/ Contraa Inde6ted�ss unoaid as of
�9 a�-e a/
Mongage I ContrarY mtlebl
date of ePPGCatian
num0el
oii
Is Ihe appMant the mle
legal a epultade wme(.�
❑ Yes ❑ No
If awned wiN someone oNer than spouse, Iriditate wiM wtom
bebw: �Is Ih!e propaty m question: MnuaM AsesseE
LSI neal PropeAY Q Mnua�y Assessed
Moble Fbrt�e (IC G7.1-7)
rel, tlry. slate, end Z/P
W /5 -
ardLPcoda)
/
Drawcr NO.... �:�11........
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