HomeMy WebLinkAboutMortgage_Ravellette (2)"'n4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 7ownship Year
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FOR DEDUCTION FROM ASSESSED VALUATION
n Slate Fwm 41709 (R71 / 6O9)
,' f p��betl bY DeD��nt oi Lxal Gwemment Fmar¢e
File Ma
(NSTRUCT70NS: '
To be filed in rson or b ma0 with fhe Coun Auditor or Coun Recorder o( the coun where the io � �2
Pe Y N b N P PertY is rocated.
FA'ng Dates: i) Real Property: Must �ile durirg the year for which the deductlon is soughG Counry AWitw
2) Mo6rle / Manufaclured Homes rmt assessed as Real Property: Musl file dunng fhe hvelve (12J months ���
before March 31 of each year the deduction is sou�ht. un Recorder
See reverse side foradditional inshuctions and qualifications. GIBSON COUNTY qUD
I APP��t (oy7ie� w conbaC 6vYP/- see rgsL'rlims m/ayerse sitla) A
�iUJ / `�- / _T I � n�meR � lesal eesa;cmn
aCo�(��f-35—y00. ao�. 5��-0
�,��,��� �g�,�������,��a �a,�
ament 1� Mart� 1, curtent yeer date of aPP��
If ro. wha[
of mortgagre or contraC seller
Addres o( mortgagee w mntrad uller (num6er and svee4 �1: sb1e, aM ZIP code)
Name af assignee
aaeress
stete,
any oNer
Yes ❑ No
Deduction appraved'u� ihe artrount of.
2�- � p- � 2�_
S9naWre
1 I We certify undu Ne penalry of perjury�Y(at the
owner I contrac.t buyer of Ne aforementioned pro
couNn auoROR
20
Camry
ning infortnation is tr
�lication is med.
sident a0tl�ess o1 epp�rcant (number arW sheef, tlry, state, ar�tl LP cadeJ
0 2 N iso w�iri�,«ro� � n� y7G ro
n auNaraed by Eidy e<ecu:eA Fbaer al Atmmey or by IC 61.1-t2-0.7
G�srn (numDerantlsbeet
someone othPi tlan spase,
b
Reco�d num0er � Page number
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Iegel or equitade ovme(1
❑ Yes ❑ No
idkate with wtwm
perty in quesCOn: Mnua�y Assessed
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