HomeMy WebLinkAboutMortgage_Halbig^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ovmship Year
__ FOR DEDUCTION FROM ASSESSED VALUATION
' "' State Fortn 43709 (R71 / 6-09)
�' � j Pr¢SCriC¢tl by Departmenl of Loral Govemment F�nce
Fil rl
�STRUC710NS: F� �� .
To 6e filed in person w by maii wiN the Counry Auditw or Counry RecoNer o! fhe county wl�ere the property is bcated. 1 y,
Filirg Dates: 7J Real Property Must file during the yearlor which the deduction is sought. MAY 1 Q rc unry Auditnr
2) Mobile / Manulactured Homes not assessed as Real Property: Must file dunng the twelve (72) months
before Ma�ch 31 0/ each year the deduction is sought. Counry Recorder
C.J.
See reverse srcle foradditional insWCUOns arM qualificatons.
AsesuE rdue d ru
Mert�h 1. ttmrlM1 Year
11 rw, whaf ¢ his I he
1t n2mC rn rem�d 6
Nat of appGCant. c�duate 6eWr:
� a� GIBSON COUNTY AUDITOR
Remrd nun er Page numCer
. 3 6 -oo
unpaid a of AAOrI8a9e I Cantrar2 uMebtedness �mpaitl as of LS Ihe aPP�� Me sole
date of aOP�� legal w epuihaNe wmrYl
❑ Yes ❑ No
H owneE with someo� other Ihan spouse. iMicate wilh wtwm
Is tl�e VbPeNY � Guestion: Mrn�aP� Assessed
❑R��m �?�yaM�...
Name o( mortgagee a mntract seller ��
Pdd2ss of rtprtgagee or cmtraci se�er (numberend streeG cey, sfate. a�P code)
Name of assignee w dher owner or hdAer of morigage
Add2ss ot assi�ce (numbe� aM atreeL c% sbte, and ZIP cade) �
Does aPWinnt wm property in any other If yes. what munt7/1 Wha� Ta�drg D'e
counry in I�eria? � Ye5 ❑ No - �—" '— _
. rna2� N�A�-'3� ���3+-�
DeEUCtion approved'm ihe amount of: n� 1 RS�jrOP jYJ�
L.�R
20_ 20_ ��� ��I�
1 I We certity under the penalry oi pe�ury that the above
owner L mntracl byyer oi the afwementioned kroperty 9
autha�aetl by duly ezecuted Power at Attaney or Dy �C 67.1-12-0.7
a of autlraaed persrn (numDer aM sneel, dry, sta(e, arM ZIP aode)
Has Ihis deduGbn been rtquested an D�Pe+b
tor cuirent yeaY.� ❑ Yes ❑ NO
zo � zo
II Date (rtnnth. daY, Yea�
3 infortnalion is W e and mrtect arM that the applicant is a resident of 1`Wiana ard
3tion is filed.
r Date (month. daY Yaa�
Date (monlh.