HomeMy WebLinkAboutMortgage_Hume^�+ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
-,-- :
s FOR DEDUCTION FROM ASSESSED VALUATION
� S1ate Fortn 63709 (R71 / 6-09)
�• ! Pfesaibed by DeC��rt of Lacal Govemment Rrance
w.
srRUCnoNS: ,O
0 6e filed in person or by mail with the CounryAuddor or Counry Recoider o� the counry where the property is located. � ��` � �
Filing Dates: 1) Real Pmperty: Must !le dunm� fhe year /or which fhe deduction is soughL Coun Auditor
2J Mo6de / Manutactured Homes not assessed as Real Pioperfy Must fiie dunng Me tweNe (12J months C , ry
before Mamh 37 0( each year Ne ded�ctivn is sought. Recorder
See reverse side tor additional instruuions and qualifications. G I BSON COU NTY AUDITOR
Ap nt (owrier orconlydC 6 r- se �' ar reverse sitle)
Tab istria Key rwmber / lega eunpUOn R¢md rvunber Page wmber
- -D - yal -003. 3� y-0�8 7 7
Assesud rWUe d real qopeny as of Mortgage / Contract intlebtedness unpaid as of Mortgage I Cono-ad i�W�e6tedness unpaid as o! Is Ne aPP��� tl+e sde
Mamh 1. axrent year Martl� 1. artent yeer date ot aPP�� iegal w equdade ameR
(� ❑ Yes ❑ No
tt m. what is his 1 hu e�oU share oi intemst? tt mme� vrit� someone other Uan spouse. iMkate wtth whom
If name on recwd is di�femnt Nan tha� o( aDG�4 mdipte Eebw. �Is th�e propaty in Qunstion: Mnua�y AssesseE
C`3'«rzl ProPerlY ❑ !�nn�alrl Asse�d . . _.
Name W rtwrry8a9� or mntrad se4er v�
7
Pddrea ot rtqrtgagce w cantrsd se0er (number e d strze; a
Name ot azsignee or othe� awner or hoNer d mortgage
AdCress of as�9gnee (_n�umb}er ami Astre�et —rdy�, slatAe Jantl Z/P a
/ � L���
Dces aOWicant wm V�P¢rtY in enY oMer If yes.
approveC in Ihe amount ot
Stete. arid ZIP code)
couNn nuorrort
20 _ � 20 _ � 20 � 20 _
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Sig�uNre of CoimNAWitw CounN Date (rtm/h. tlaY. Yea�l
C•T
I/ We certify under ihe penalry of rjury that N antl (oregoing miortnation is W e and cortec[ and that the appikant is a resident o( IMfana and
owner I mntract buyer of the aforementioned rty on date appiication is filed.
Sig�a owne�s Iu0 name) Date (morah. daY. ysa�
�,� /1 L,/
Full rnsi0ent atltlre� of applicant (numGerard sheet, city, slste, and LP ootle)
1709 eo� _ :� �., e��. n/ 767d-
Person aWar¢ed Ey aWy execu:ed Power al AttnmeY a M�C 61.t- 2�.7 �ate (montli. Cay, yee�
Atltlress of a W�oraed person (numbera�b sbee4 tily. sfafe, aM ZIP code) .
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