HomeMy WebLinkAboutMortgage_Queen^y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION ���
• Stace:orm43709(Ri1/6-09)
�` � pr¢soib¢tl by Departmenl af Loral Govemment Firence
File Mark
wsrRUCnoNS: MAY 30 2012 FwmAedwiN:
To be ned in person or by mail wiN the CountyAuditor or Counry Recorder of Ne counry where the properry is located.
Filing Dates: i) Real Property: Must file dumg the year /or which the deducfion is sought. C, � County Auditnr
2) Mo6ile /Manufactured Homes rrot assessed as Real Pmperly Must file danng [he tweNe mpnths
before Mamh 31 of each year the deduction is sought c\ County Recorder
Seereversesidefora iGOnalinstructinnsarMqua/ificatans. GIBSONCOUNTYAUDTOR
Aoofranl (owner w mn GuYe.- seg mstiiU�ons on 2Yerse si]e) � . �
q5sessed v
MaU 1. a
tt ro. whal
If name on
�//_
of MortgaBe�tran ��
MarG� 1. t
�G sliaie of intuesl?
lerent lhan ihat of aPp�N. uWimte 6elaw:
rnntraG seller
of mortga9rE or
of assg�ee or
raG se0c (numbe� and svaeG cily. steffi. and ZIP code)
mer m twWg W morcga9e
ariC street, ciN�' a)
�oes app6mnt own.�
munryinlrW�� �
� I
-' �u�,; �,,�,,�y
t ia-��°�
.�
t munlyl
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I/ We certify under the penalry'oi perjury that Ihe above and
owner / mntract buyer of the afwg�nentioned property on da
by
p¢rson (num0erarM sbeef. dty, state, aM ZIP oode)
WhatTarirg
�v�'Y
��
�ka61e ameY?
Yes ❑ No
sonieone atlter Ihan 5pouse. iMitale
�s u,e a�m m a�: w,n,:
❑ Rza� Rovertr ❑ lw,ua�
Moble
Nas Na dedutlion Eeen re9unsted m P�W��Y
m�a,�cy�r n ..__ n
Zo_ , �— , �
Date (monfh, daY• Y��
�_
infomia6on is We and cortect and that the applipnt is a resident of IfMiara aM
ian is filed.
Date (nmth. daY. Y�A
daY. Y��