Mortgage_Parrish^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun�
_ - FOR DEDUCTION FROM ASSESSED VALUATION
� Sfate Fwm 43709 (R71 / 6-�)
�' � Prrsm3etl M �eP�M of Local GwemrtrerR Friarce
INSTRUCTIONS:
To be fifed in person ar by maiT with the CounryAWitor orCounry Recorder o( the counry where tAe property is located.
Fifing Dates: 7J Real Property Must fJe durirg the year Por which the deducLOn is sought.
2) Mo6de / Manu(acNred Nomes not assessed as Real Pioperty: Must Ae during the hveHe (12J months
befae March 37 of each year Ne dedudion is sought.
See reverse side /or addifiunal inshucUOns end qualifications.
Anrd minamarrvmnfrarlh.iwa.`-seemNri-�'v�ncenrevPiu<iin) •
--/� -/ /
7or[gage / CantrarY u
Ia�U 1, airrent year
n�.,�«�,�,e,��o���
If rwna m remd'a dR. emnt Nan Mat ot aDP�l hMirate below.
rume rn rtnr�a9ee u mnu-aa aener
Address of rtwrt9agce or mnbad seller
�1' F�
i ot asvgnee w omer ovmet or tqwer at mwtgage
rss ot as9gnce (number aM s(reet Ury, stete, aM LP mde)
T /"]— ot _ /
ePplifant own property in any oNer If yes, what
y m Irdvna? ❑ Ye5
❑ No
c0an approved'u� the artmunt ot
zo � �
I I We
��� �
under the penalry of perju at the
ad buY�+of the afo2mentloned proi
���C' P.udrtor
Counry RecoNer
��� GIBSON COUNTY
aewrd numeer
Q � ���. ��� � 0 � � �
dness unpaid as of Mongage l Contrarl i�M
Cata of appGrationO
It awned with mmeone otl
�
couNrr nuorroR
zo_ �_
Caunry
nd foregoing Infortnation is true and corre�
date appiintion is fiied.
1
auttnraed by dWy execweE Pwri al Atmrt�ey w �y IC Gi.7-12-0.7
: of author�d C�� (numbe�arM sbeet uN. state. erd ZIP ootleJ
ehteMess unpad as U ls Ne appGrant Me sole
kgal or equitable ameR
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