HomeMy WebLinkAboutMortgage_Hurt (5)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township vear
__ .� FOR DEDUCTION FROM ASSESSED VALUATION . ..-�
State Fofm 43709 (R71 / 609) .
�' p Presaibed by DepartmeM of Laal Govemrtrerrt Frence '
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File Ma
�vsrRUCnoNS: C
`�To be filed in person w by mail wifh the CountyAuditor or County Recorder o/ the counry whe2 the property is located. D C ° m e
Filirg Dates: 1) Real Property Must file dunng fhe year for which the tleduction is soughf. C Counry Auditor
2J Mo6ile /ManufaUUred Homes rrot assessed as Real Properly Must file dunng the hvelve (12) months
befom March 37 of each year Ihe deduction is soiqht. nty Recorder
SeereversesideforadditionalinstrucGonsandqualifications. GIBSONC NTYAUDITOR
AppGp wreroryontrartb r-see re side)
� 7 g Key rnimber / legal desaiption Reco�d nu Page numba I
o,-t� a -o - 5 -400-000.6o3-oao (�
Ass�s¢tl rahc cf real qoperty a d Mortgage / Cantraa intlebtetlness unpaitl as ot Matgage / ConTaR indeDtetlness �mpaid as of Is Ne eppGrant Me sde
ntard� t. arma rm Marrli 1, artrem yrar aate m eaa�� � a ew�� �'
I( ro, what is his l her eaa1Y share oi
It name m remd a QMeren� Nan tt
k
Name M nnrcgagee ar mntratl se0er ��
�
lddress W mat9a9ee' ar canbaG 5e�er (numbr� ar�
Name at assi�ee w other owner w Ml�er of moric
Adtlress af assgnce (nu�� �/
f
Opes apyirafq oxn property in any o�her
munryinlrWeru? ❑ Yes ❑ No
approved in Ne amounc ofi
i�Wifate 6Pb�r.
"-'�J 'v+
cGy, stafe. aM
ir y�..+,ai �ory,
20 _ � 20 � 20
I I We certify under ihe penalry of perjury tF�f the above
owner I contract buyer of the aforementioned pmperty o
/ � � �
VJhal Tadng Di
I O O d(7 ❑ Yes ❑ No
mew�e oticer Ihan s7�+�. iMicate wiU wMm
h tlie OropertY m Vu�Ymn: Mnuay' Pssesed
eal FnPenr ❑ nnrwa�N wsse�ed . . .
E—Ic.Q/r-� 132-�� ��
� I f Vi � • V'
20_ 20_ 2b_ 20_
Counb Date (rmNh. daY, Yea�
regoing infortnalion is We and cortecl and Nat Me applirant is a resident o( IrWiara arM
applirabon is filed.
Date (rtionN. day, year)
Full msitlfrit address of applirant (numberand sbeet, riry, sfate, antl ZIP ootle)
�oOZ �✓lo�l<a�n �D�. l�2fal�qi (2�
Person aulMfaed Dy Ouly exewted Power oI Altomey w by IC G1.1-12-0.7
P4dress o( autha'ned person (number arM sveet cky, sfate, and ZIP mEe) .