HomeMy WebLinkAboutMortgage_Thompson (11)^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun hip
� FOR DEDUCTION FROM ASSESSED VALUATION
:r'— . .
. S1ate Fortn 43709 (R11 / 6-09)
�' ,w Presaihed by DepartmeM o( Lmal Govemmenl Frence
��srRUCnoNS:
F � 2011
To be filed in Y N N N P PertY F� �� ��:
person or b maii with the Coun Auditor or Coun Recorder o! the ooun whe/e the m �s located. „
Fii'mg Dates: 1) Real Pmperry: Must file durirg Ne year (or which Ihe deductlon is sought � Coun u r
2) Mo6ile / Manulactumd Homes iat assessed as Real PropeRy Must h7e dunng Me fweHe (12) rtronths
before Maah 31 of each year the deduction is sought ❑ Counp�� OR
G BSON COUNTv
See reverse side for additional instnictions arM qualifications.
;so-fa ' Key rwmeer � le9a� eesai
a -�a - o -ao 3 -cb-
frdueamal�popstyasw nMtMgage�cono-aaindeeted�ressunpaia
qu�anyear afd�t wrtentyem
If no, what s his / her e� share ot intrsest'�
1f nazne m remE is dilferent than Nat ol appGCant. UM�.
Name N mortBa9ee or mntract seAer
oN,
Addrces of nwrtgagce w contract se0er (numhrs and e
Name al assi�ee or ahei owner w hdder o( narigay
Mtlress of asvgnce (numDerarb stree4 mY. slafe. e�
Oces applimnt own property in anY omer
munry in IMeru?
❑ Yes ❑ No ,
� � �
Dedudion apprwc-0 in ihe amount E
20 20 _ 20
, •.��5':1
Is Vie aPP�� tlte 5de
�gal n equBade v.vne(.�
❑ Yes ❑ No
spouse. md�te wiTh wlam
Is iM property in Question: MnuaM Asessed
�`Real Pmperty Q MnuallyA�ssed
a�ome rwne nc s-�.�
D�-�„���- ��o....Q?Ol.l......
�z�-� �o: .:..5.�a�::....
�) •-c. '
iW51h5 E¢tluoion Eeen reQUesteE an pmpelty
(or wirent yeaR � Yes ❑ I
20 _ � 20 _ � 20 _ � 20
Date (rna+Rh.
I I We certify under ihe penalry ot perjury that the above and foregoing infortnaUon is W e and corteU arM that Me applipnt is a resident of IMiare ard
rnmer I mntracl huyer of the afrnementioned property on date appiicaVOn is filed.
ircmvw lonnels M9 nanie) Dale (morrth. daY• Yaa�
Dw acvGran� (rwm��
KP.J.�I £�o Y A�
by dWy ezecutetl Power o( Anomey m Dy
61.7-12-07
Pddress of authoraed persm (numberaM street dry, sfate. and Z!P ootle)
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