HomeMy WebLinkAboutMortgage_Bobbitt (3)"' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
.__ FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 93709 (R11 / 609)
�,�. PresaibeE by DeparlmeM a1 Loral Go�emmarit Fnence
File Mark
INSTRUCTIONS: A� G q
To be filed in person of by mail with the County Audiror or Counry RecoNer o( fhe counry where the property is bcat �
Fifirg Dates: 1) Real Proparry: Must fi1e durirg Ne year /or which the deduclion is soughL County Auditor
2) Mobile / Manu/aGU2d Homes not assessed as Real Property Must file during Ne tweHe (12) montlys,.,
6efo2 March 37 0/ each year the deduc0on is sa.ght. ��(� � County Rearder
Seereversesidetoraddilionalinshuctionsandqualificatbns. GIBSON COUNTY AUDITOR
MP��� ( mntraC 6uyer- see restrirdwls m re er�s'de) 1 � �(
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Madi 1, nimrt year
n�a,��ns�n��ay,arewo-
n rame n, rec«a s srtuent u,an u,at
Name af rmtga9ee a mntract se0er
aeeress ot morcga�ee w m,o-aa seo
Name of assignee or Wher owne�
AEeress ot assiqnce (numbr
Dces epp6mnt awn praperty .
munry in Intlana?
❑ Yes
OrduCion aPWnved'ci Ihe amoun[ aE
�Y`.�'�`0'�6'- � 17- I D�Oc�- I� 7-0� I��
Abrtpage / Con7au irdebteG� unGaid as d Mortgage / ConSU1 mEebteMess unOaN as
Mard� 7, arte91yeer, _ date of app�tltan
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Yes LI No
�e P�W�rtY in Ouesiim: MiwaOy Assessed
Real F.oaertv ❑ Mnualir 0.ss�s�
Has Iha deduGia� been
rw w�,c yPan
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� G�W�Y
20 _
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I/ We ce� under Ne alry o perjury t the above a� foregoing infortnation is true and correct arM ihat ihe applipnt is a resident of Irdiara and
ovmer / mntracY buyer e afo2me � P�PertY on date aPd��n is 51ed.
�naNre (owre fu0 name) Date (ma#li. deY, yeen
�
�ll residerrt a0tlress of appl'mant (numDer aM sbee( dry, sfate. antl ZIP wde)
i/Oo /� Ohro 57�: �i'' n Cr'-�t� �N L/7(�7d
yson aWaraed 7y dWy ezecuted Power of AttaneY m by IC 67.1-12-0.7 Date (monN, daY. Y��
P4Cress of autlmr'¢ed person (numberaid sbee4 �/�: smte. antl Z!P code)
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