HomeMy WebLinkAboutMortgage_Ledbetter^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Counl
_ � FOR DEDUCTION FROM ASSESSED VALUATION
� Slata Fortn 93709 (R71 / fi09)
. �' Prnsvi�etl by DeP��N of Loral Govemmerd Finance
�INSTRUCTIONS:
To be lled in person a by mail with fhe County Auditor or Counry Recorder of the counry wheie the property is located.
Fiimg Dates: 7) Real Property: Must file d�rirg the year (or which Ne deduc6on is soaght.
2J Mobde / Manufactured Homes rat assessed as Real Property Mus! file dur'vg the twelve (12J mon(hs
befora March 31 0( each year the deduction is sought.
See reverse side /or additional instructions and qualifications.
MP�n� (uwlwl0rconvalr buyer- see resvk'b'orts m raverse sile) ' _ ..
GIBSON COUNTY AUDITOR
C.
File
2� 2B4q^ry�d��
U Counry Reoorder
w�sm � d� woaenv as w
Mmd� 1, aarenl year
It m. what fs his / her exaG share al interesi?
If narne on �emfd is
w mntraa seller
Pddress of mortgagee or mntraa u4er (nurr�er antl sfree4
�cono-aa
Nameofassigneeolatlurownu..�••+'-'_"' ��!7��
�rz �2� , �
pc.r „'
AEdress of assicy�ee
Does eQdimnl Ovm p ' I/ I�J ��
munry m Intlana?
approved In 1
�_
SigraWre of CountyAWitw
unpaid as of Mwigage / ContraC indebtedness �mpaid a d is Ihe apd�l tlx sde
tlate of sPP��^ � w eWitade ow�re!!
❑ Yes ❑ No
H ow�etl wiM someo� aMer ihan spouse. indicate wM wMrti
CNl o�
�aa�
_{
Tarirg Districl?
Is Me WoPenY in 7uesGOn: Mnually PssesseA
❑ rteat a�opertr ❑ nm,ua�N wssess�a
r�oa� r� nc 6�.
Nas Uis dedurSOn been repuestetl m propelty
for current yea(± ❑ I
❑ Yes
zo _ � zo � 20 _ � Zo � zo _ � zo _
�Y r�en
I/ We certify under Ne penalty ot perjury Nat Ne above and foregdng infwmalion is true and wrtec[ and that the applinn[ is a resident of IrWiana and
owner I contracl 6uyer ot the afwementioned Property on date applipbon is filed.
steer.
or by IC Fi1.142-0J
Address of au4wr'ved pe�'..on (num0crand sbeet dry. state.
Date (rtanN, day, yea�