HomeMy WebLinkAboutMortgage_Nelson (5)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
� FOR DEDUCTION FROM ASSESSED VALUATION
� Slata Fam 43709IR71 / 6-09)
� Prescribed M DeP�reM af Lacal Govemment Firiance
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�STRUCTIONS: F� m� �:
To 6e filed in person w by mail with the CountyAudifor or Counry Recorder o/ the tounty where the property is located. r�y ��n �� ,
F rg Dates: 1 J Real Pmperty: Must file dunrg fhe yrear for which tha deduclion is soughf. �� ' lYi 'L Auditnr '�
2) Mo6�e / Manufactured Homes not essessed as Real Property Must file dunng fhe twelve (12J monNs i
before Ma�ch 31 oi each year the deducfion is sought. ,'J, �,i...�nry Recorder
See reverse side for additional instructnons arrd qualifications. �
`��(ownerar rtbuyer-see mreversesile GIBSON COUNTY AUDITOR
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Tad{�q Oistrict ' ,/. I Ke'.
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Mamh 1, ac�ml ye.ar
ir�o.�ts�in��a�a�,�
If n3me on rew�d is d'Aferent Nan fhal o( ��
Name of rtrortgage r contract seller
� ..O11-M'lv.�ti
Pddtess of rtortga9ee or mntraa uAer G
Name of assignee w oNer ovmer or hdd�
ACtlress ot assi9nee (number eM stree4
Does aPplimnt ovm ryoperty in any other
couniyinlnd'aia? ❑ YES
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rosU�r�x' m a��orow�'v� tlre amount oE
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SignaWre af CaunNAWitor
20
IOer/legal
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�a�mc� new�
dry, srate, ano cir poae�
u,res. wha�
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��9� � 4We6teMess �mVaid as of I
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�t owiea win someane ahni aun spouse. SieKate
aM LP cada)
couNn nuo
Is the P�v�Y in auestion: Mnu�
L�Real Roperly ❑ Armual
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Yes LI No
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llra��er NO...�.�.�� �
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Caunry
yea�
I/ We cert'rfy u�er ihe penalty of perjury ihat ihe above arW foregoing infortnalion is W e and correG arid Nat Ne applirant is a resident of IMiara aM
owner I contract buyer ot ihe aforeme�rtioned property on date appliration is filed.
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and sheet aN sGte. ard LP cotle)
on/�' S7; PR �N�Efian�, �
�WAttomeYarDyICG1.742-07 �
P4Ernss of autha'vN percon (number aM sbee( cay, sbte.
Oate (monfh. daY.