HomeMy WebLinkAboutMortgage_Pullum� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
_, • FOR DEDUCTION FROM ASSESSED VALUATION
� State Fwm 43709 (R11 / 6-09)
�' Prewibed M DePa��M of La�� Govemment Fuance
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INSTRUCTIONS: F� �� �:
To 6e tled in person or by mail with fhe CowtyAuditor or Counry Recorder ot the county where the property is located. E P S �
Fifirg Dates: 1) Real PmpeRy: Must file dunrg the year /or which the deduction is soughf. � ��unry AuditDr
2) Mo6i7e / Manufactured Homes not assessed as Real Praperty: Must file dunng the twelve (72) months ��']
6etore Ma�ch 31 of each year the deduclion rs soughG C.�. aw.�� L Counry Recorder
See reverse side fo� additional instnictions and qualfications. �1
np�r�t(owne�ucono-anbuyer-seereit�tionson vde) , � w GIBSON COUNTY AUDITOR I
d
ro, what Is his / tw! e�mct share ot inteiest?
tt narne m reco�d
N2me of mw[gagee or mntraU seller �
MAm_cs of nnrtoaoee ar mntraM seAer (n /
-8':-�=�,00 _ oo y. 3�r8-o �
Mp�q�ge / Contraa inde6tedness unPaH as d Mortgage / Corts
Marrh 1, wrtent year tlate of appfimtz
other avmer w hdder at mvtgage
Ae oi assgnce (number and shee4
� 5 E NE
Dces applimnt ovm property in any oNa
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Page numbg
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Ls Ne appfirant the wk
Iegal w ew�de orrtml?
n Yes ❑ No
spouse. kMi�ste with whom
P�GeNY in Guestion: MnUaDY Assessed
eal Pfoperry ❑ MnualyAssessed
Mabile Fbme (IC 61.
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Dra���er NO...�S/�
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I I We certlfy under the penalry of�perjury that the ab�ve arW foregoing intortnation is We and correct aM that the applinnt is a resident of IrMiara aM
owner I contract buyer ot the aforemenlimed pro�� on date appficatlon is filed.
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Pdtlress of auNoraed perswi (num6erarW 51reeG dry. state, andLPCOde)
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