HomeMy WebLinkAboutMortgage_Gabbard (3)"'� STATEMENT OF MORTGAGE OR CONTRACT II�DE��E�S un Township Year
__ , FOR DEDUCTION FROM ASSESSED VALUATI�A �-1
State Fortn 43709 (R71 / 6-09) 1"�
�' ,,,. f Prescibed Dy DepartmeM of Ldal Govemrtrent Firunce
�sraucnoNS:
OCT 7 2011 FileMark
Fwm t�ed wiih:
0 6e filed in person or by mail wi(h the CountyAUdifor or Counry Recroider o/ the coun is located.
Filirg Dates: 7) Real Pmperry: Must file during the year Por whicA fha deducGon is sought. � unty Audimr
2J MobAe /Manufactu2d Nomes rrot essessed as Real PropeRy Musf file dunng the months
beforeMarcA37ofeachyearthededuclionissaghc GIBSONCOUNTYAUDITOR CountyRe�rder
See reverse side fo� additional instnlcGons and quali�cations.
Appfuani (owner mconvact byrer - see resN'cGq�¢ m reverse sid�)
�,�d����
artent yrar
her erad share of interesl?
rllCgale¢Smp(wn RecWdnUmber PagenumCu
- -/ -ZO ooaF�S7oa p 7
Mo2qageNContraa uWebtedn�s unpaiC as of Mortgag�� @Wehtetlr�s �mGaitl as of �I � de owne(1
Marr3i
❑ Yes ❑ Na
If ovmetl with wmeorre other than spouse, ifMinte with wlmm
�. uWirate belovr. Is Me P�PenY in 7ues6m: Mram9y AsessM
�RealRoPeKY ❑Amu!allY 'A�cs�.._ _ _ ' _
Name af rtnrtgagee a mnttaG sWer //�
AAtlress of rtartgaqee w wnbacl sWer (num6e� and sn
Name ot assigncre w at�u owner or halder o� mortgage
Address of assynee (number aM stree4 ciry. siete, and
Oces appiimnt wm pmperty in any oNer
�,� �� ma�?
❑ Yes ❑ No
DeducOOn apprwed in Ihe t.
2�
Sigruture af Counry AuCimr
�
ee4 �y. sbte, aM ZIP code)
Z/P totle)
If yes, what counyt What Tarin
// COUNTYAUDROR
�_ i zo i �_
Counry
Drawer NO.. �(�(�.........
. .
Card 1�'O. ....�:{..� � 7..:.
$57,1 q�.y�
ZO_ N_
t I.
I Data (rtnNh. day. Yea�
i
I/ We certify urWer �he penalry of perjury that the above antl foregoing informalion is true and cortect and that the applinnt is a resident of India� arM
owner I contracl buyer of the aforementioned property on date appliptlon is filed.
i�aPve (ovmeYs full name) .. �/ Date (month, daY. Yve�
riry,
�Y•Y��
person (numberaiM saee4 �ry. sbte, aM LP code)