HomeMy WebLinkAboutMortgage_Ledford"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Tovmship Year
_. - FOR DEDUCTION FROM ASSESSED VALUATION
� n State Fwm 43709 (R71 / 6-09)
�' � Presrnbe0 M DeP��N of Lnrvl Govemrtrerit Firarice
� FI rk
INS7RUCTIONS:
To 6e filed in person or by mail with the CourrtyAudi[w or Counry RecoNer of the county wheie the pmperty is focated. F� �� w'�'
FiRrg Dates: i) Real Properly Must fJe during Ne year (or which the deducUon is sought � V�p�,��
2J Mo6r7e / Manufactumd Hanes rrot assessed as Real Pmperty. Must fi!e during tAe hvefve (f 2) rrwnths
befae March 31 ot eacA year the deduclion is soughf. � �e�
See reverse side for additional instructiwis eM qualificafions.
npp�ram(pthj�orcalyaebuy�r-se re' reyarses'ste) _ �^ _ GIBSON COUNTY Al1D1T()R
A�sessed vdue d real puaperty as
/Aa�U 1. amen� year
11 ro. wfiat is his ! her e�md share of interestl
as
tl name on recard is 69urnt than Nat of aPP��l Ndicate behw.
rtnrtgagre w mntra�] seller
of mortgagee w mntrad se0er
Name of assignee w othel awner ar holder of rtqrtgaga
AGdress of assi9rree (num6u aM street ciry. stafe, aiM LP �
� w�vem
OPduction appmved'ui tlie amount of:
Zo _ i zo _
N Ca�mN nwimr
ncr�
`I
sameona
If ye:
DI"8\1'CC ��. �O.I..`�. .......
_ - 59 o I �
zo C11'd \O . .. ............... .
—0,�. .� �o�oco.�O
Remrti
btedness unpaid as of Is Ne applinnt ihe sole
legal or equitaNe avnM
❑ Yes ❑ No
spo�ae, iMinte with whom
!s the P�P�Y in auestim: MnuaM Assessea
❑ Rra� Roa�v 0 ���N �
Modle Home fIC 61.
Has Na Eetludion been requeste0 on praperty
for arrerrt year+ �
❑ Yes
2� � 2�
1/ We certify under ihe penalry of perjury that the above arM foregoing infortnation is W e and corteU ar�d fhat the applicant is a resident of IrMiana aM
owne�ntract buyer o� atorementioned property on date appfication is filed.
3 wneYS h� a�m Date (mmM, daY• YBaA
stare,
ar by IC
otauthoraedperson (numberantl
_ . I Date (rtpnN. OaY. Y��
l'1