HomeMy WebLinkAboutMortgage_Leathem"'�v STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun
__ .: FOR DEDUCTION FROM ASSESSED VALUATION
� • S1ate Farm 43709 (R71 / 6-09)
�,.,� � Resrn'Eed by OepartmeN at Lorai GovemmeM Fi`w¢e
INSTRUCTIONS:
To be filed in persan or by mail wifh the CounlyAuditor or Counry Recorder o/ the caunty where the ploperty is bcated.
Filirg Dates: 1) Real Pmperty: Must file dunrg the year for whicA fha deducfion is sought.
2J Mobde /ManuFadured Homes rrot assessed as Real Property: Must fi7e during the twelve (12) months N�
6efore March 31 of each year the deduction is sought.
See reverse side /or addifional instrucdons a/W qualifications. C��
AvB�Z^� (��"'�+e� rconhae buyer - sea resviCiais m reverse siie) r e
Fiie
8 ❑ � rGaunty Auditor
❑ �Counry Recorder
GIBSON COUNTY
Ta�org Districl Key rwmber / legal desaiption Record nom6rl Page numbni
a-� ._ oi-aoo. s�s_o �6 or s�9S�
As�ed raAm of real pioperty as of Mortgage / Contra�3 iMehtetlness unPaid az o( Mwigage I Contrarl'vWebcedness unpaid as of Is Ne a0P6rant the saie
Mamh 7. ncmV Year Mazth 1. current Y� datc of ePPOre' legal w equitable oxneR
�O [7QO ❑ Yes ❑ No
tt no, wfiat Is his ! her eraa share of intuest? R awned wFJi someone other than sprnrse. mdKate wlih whom
narre on
IJarrre of mort8a9re w mntraa
Address of nwrtga9ee «
OOfSE
(1M1�'
ontra& se0er (numbrs aM 4reeL �: s+a1e. ard ZIP mde)
ownu or holdu ot mwtgage
�er and sbeet cify. slste, arrd Z/P oode)
' o �t Si �
ry in any oMc Ii yes. wha[ ty? VJhat Tad�g D'si
❑ Yes ❑ No
�Ipst(� W�P�Y in Ques6on: MnuaMAss¢�ed
L7rtealProPenY ❑!vmuaMP�sed
DI':111'Ct" ��..�!�!,I�..�.....
cz���i �io. ....�`..'�lq5........
7q,�43.9�