HomeMy WebLinkAboutMortgage_WoomerSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C' n-' vear
_ FOR DEDUCTION FROM ASSESSED VALUATION �
Slafe Fartn 43709 (R70/71-08) � J
� � Ptesaibad bY �PaMnnt d Loral CmammeM Firerim
wsrRUCnoNS: 2 �i�ark
To be fAed in person ar by mad with the CounfyAWifor d the oounry where Nie poperly is IocafeC.
Ftiiry Dates: i) Real Property: Musf file tluring the yeer for which the dedudion is sougfit '�n
2) Mo6de / ManulacLiretl Homes nW assesse0 as Real P�operty: Must ke durirg.lhe tweNa (12) mohf �hsbe(� 31 0/ each year
fhedeductionissayht. GIBSON COUNTY AUDITOfi
See reverse sde /aradditional instrudions antl4�lifications �
aE v�ue d real RWeM
1. omartl yax
no. what ¢ ha / hm wad ahara d inmresl9
m
Address d rtnrtpapea or
Uian thal M apV�. �+7irata Ceb�r.
r�a�a���«��«��
�sgnea,muroa am me�. er, s�m. ano �,-wae,
% ^. � —
Dedudion aGCmved in tlie amauit d:
�
Signalura d CauMy Autlilar
-Ooo•� 8' 3 -0�,�
debledfress unpaitl as d Matgage / Contrac� indah2¢tlneu un{eid as d Is Ihe appfinN Ihe
Cale of applimtion . �egal w eGUilable owne(t
� [� Yes ❑ No
If owned Wh someona olher Iti2n 5pou58, iMitate wilh whmn
Is me wWeM � auesfion: nnnuaM assassea
. [�Re� ProPartY ❑ MnuanyAssesmd
Mohi@ Hortie (IC G1.1-7
Yes. wM� �Y7 I NRat Tasi�
/��
� COUN7Y AUDI70R
20 � 20 � 20 _
Camry
C.�DOIY� E�, J AMt.$ O
S,�«y �.
��-dS��
zo I zo I 20
I I We certify uMer the penalty of perjury Nat ihe above aM faegang 6ifomiatbn is true arb cwrect and that the a�cant is a resident of Indiaria aM
ownedf�Vad 6uyer of ihe aforementionetl property on Aate apv���hon is filed.
F W m§iEeht address d appfifant
��
sboal. �: ata�. aid
oa�e cma�rn, eay, r�
— . __-�