HomeMy WebLinkAboutMortgage_Collins (3)'^'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS count
_ FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fortn 43709 (R71 / 6-W )
�` „�, � presoihed by Departmem af Local Govemment Finance
INSTRUCTIONS:
To be filed in person or by mail wdh the CountyAuditor or Counry Recoider of tAe counry where the property is located.
FiTrrn� Dates: 7) Real Property: Must file dunng fhe year for which tha deductlon is sought.
2) Mo6ile / Manufactured Homes rrot assessed as Real Property: Must fiIe dunng the (welve (72) months
6etore Maich 31 of each year fhe deduction rs srought.
See 2verse side fo� addiWnal instructions aml qualifications.
MP�^t (awner oY�^sP� b"�L- � fe'StP�O^s ��iipe�n .
ormal n�r as a
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1f narne m recwd s d�RUm[ Nan th
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March 7, �
ufaipte Oebw
Name N mort9a9ee w cvntraa sellu �'
Address of mortgagee or wntracc se�er (mmbe� aM sbeeS �Y. stafi.
Name of assianee w oMer owner or twlder of mortgage
T
Year ��
f r0 LUIL�
Counri Remder
GIBSON COUNTY
R¢cortl number Page i
1 as W Mon8a9e I Contract @qebtedness unDaid as d Is the ePP�^t me sWe
Oata ot aGPOm� k9al a M�itatle ox+�eYt
❑ Yes ❑ No
If o�med wiN someone aUrer Man sP�e. iMkate Wih wtrom
Is Me P�GQnY in Question: MnuaOy Atisessed
❑ Real Property ❑ Armuaily Assessed . .
ACtlress ot assignee (number aM stree4 �Y. �. � LP code)
Dces appiiont ovm properry in any oUer If yes, what munp? VJhat Ta�drg Distritl? Has Nis tleducTiai Deen fequestrL m propeM1y
cwntyinlndana? ❑ Yes ❑ No IwarrentyraR _ � Yes ❑ No