HomeMy WebLinkAboutMortgage_Blackburn (4)^�� STATEMENT OF MORTGAGE OR
__ : FOR DEDUCTION FROM ASSES:
�• Slate Fwm C3709 (R71 / 6-09)
�,�,� � PresviEed Ey DepaNnent ol Lnral Goremrtrent Firerx
MAY 1 6 2011
INSTRUCTIONS:
To 6e lled in per5nn Or by mail wifh the County Auditor or Counry Recorder ot Ihe c�n�ul�ikp���rty is bcated.
Filing Dates: 1J Real Property: Must file durirg Ne yrear (o� which the deduclion is soughf.
2) Mobile /Manulactured Homes rat assessed as Real Property: Must file during th tw 127 montAs
6efore March 37 o/each yearthe deduction is sougAt GIBSON COUNTY AUDI�OR
See reverse side for addi�l inst/uctions arM quali(rcatiofts. �, ^
� n —�—�
App6mnt(oirneror 6 . va� e)_ _ � n c i, n ,. / I.
File Mark
Fwm filed vnth:
� CaunryAUditor
❑ County Recorder
���� J KeY nunber /��a - a� 3�5�-� ��� D� � Rem(d ^4�^ V 1( P�e �/ 1 /
O�
eC vd4ie of real WoP�Y as d Abrtpape / uitlebtedness unPaid as of Mortgage / Cantra�Y mtleMetlness unpaiE as of Is Vie aOW�a^t Ne sde
I, arta¢ yrar Ma� � Eate of appGptqn legal w equila6le ow�Nl
��� ❑ Yes ❑ No
�( M. Wfld� 6 �I15 / iMf CITGi 5�1218
It name on remrd a diflwent Ihan Ihat af aPpGwn, utlrcate Eebw:
Name of mwt9a9ee or fnntrad a OI �� V' I+ I
naa�m�a�m ��f}�113U1�� uVNAL/� �2 �
°w^ ��d,Sdd`� �ut'l7� �-
someone other t�an spouse. irM"cate with
Is tlie OroPenY in Vuesuon: MnuaDY AssrsseE
❑ Res� Ropertv Q AmwalN As�sed
ndcress ot assig�,ee (numae,a
m�G�' ytNt STU/LS
Does aPplimnt wm pmperty in any oNer I If yes. what counp? What Ta�drg D'atrci? Has Uiis deductan Deen requested m Pmperty
munry in IMaria? ❑ No far artent yeaYt
❑ Yes ❑ Yes - ❑ No
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