HomeMy WebLinkAboutMortgage_Lipscomb^'�4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coun
__ ._ FOR DEDUCTION FROM ASSESSED VALUATION
� Stata Fo�m 43709 (R11 / 6-09)
•�' w. 1 Presmbed 71' DePartmerit af Lowl Govemrne�rt Frence
INSTRUCTIONS: ,
To be filed in person or by mai7 with the CounryAuditor or Counry Recader a/ the county where the pioperty is located.
FTing Dates: 1) Real Property Must fJe during Ne year Por which the deduction is seught.
2) Mo6de / Manufactuled Homes not assessed as Real Property. Must fiie dunng fhe fvrefve (12) months
before March 31 of each year the deduction is sought.
See revarse side 7or addrfional inshuclions and qo�lfications. _ �
��.yu� � �v:Y nua � � I
/ l/
� —
Aaased vehie d real qopaty az ot '�.1��g e/ ConbaG i
Mard� t. nment year Marrh 1. curtem yrs
tt m, what is his / her e�G share ot interesi?
If nane m remrd's QAfemnt Nan that ot appOCan, uW4ate 6ebw
Name af mortBa9� w mntrau seuu\ //�
PdEress of mortga9ee ar mntraG seller (�
Name o1 azsignee w other owner or holder of morigage
Pd7R55 oi auignee (numDer arid 5tlee; cily, Sfate, anE
Ooes ePplicanl own property in any o0
counry m trW'ana?
❑ Yes
Deduction appmved'u� ihe amount oY.
20 20
�vl
] az ot rnm
��
tF wmed xi� �.
ee� tit}; sbte. ardZlPcode)
�� � �/ � / /�
LP catle)
If yes, what munlyT Whet Tatirg
COUNTYAUOROR
20 _
I/ We certify urWer the penalty of perjury that the ab
o w n e r I c o n tr a c t b u y e r o f N e a f o re m e n tl o n e d p r o p e r
/ � (ovmmYSTw me),
'`
`/ W revdent address W appGc
1`
Pe1sm autha¢etl by duy ez[
Pddress ot autho�aed pusm
��.udrtor
CounTy Recorder
��J GIBSON COUNTY AUDITOR
/oo � Rem numbe� Page�(iu�
Q �°t �
�e I CantraG' ebtedriess unpaid as d LS the apPGOnI �he
aPP kqal w equita6le owneR
� . � ❑ Yes ❑ No
3e. h�d¢ate with vA�om
(e prapeny in puestion: MnuaMAssesseE
Real PfoPeAY ❑ A!?i!�a��Y A��sed . . .
�i�
Has Nis deduGion been re9ursted m p�opelty
!or aurent yra/1 n Yes ❑ No
�/ � 20_ 20_
DI'�1VCC ��............ J... oa�pmnm.aar.rea�
C a C d�1 �••" ll', ��( •••• 3pPlinnt is a resident of IrWiana ard
� I I �' / /l �' � Date (month. daY. Y��
(J
Poodel _ i _
of Atbmey w Cy IC 67.742-07
'sbae; rify, S7ate, eiMLPOOtleJ
��