HomeMy WebLinkAboutMortgage_Blackburn^'n STATEMENT OF MORTGAGE OR CONTRACT I���E rownsnip Year
: FOR DEDUCTION FROM ASSESSED VALUA
� State Farm 437W (R71 / 6-09)
�' � pr¢soibad Ey Department of Lacal Govemment Fruxe
�µ File Mark
wsrRUCnoNS: DEC 2 8 Z��2
To be filed in person w by mail with the CounryAUdiror or Counry Recorder of the counry where the pm rty is bcated. F� �� ��
FiNrg Dates: 1) Real PropeAy: Must file dunng the year lor which Me deduction is soughtC �. County Auditor
2J Mo6de / Manufactured Homes irot assessed as Real P�operty Musf fife during fhe hv ( rtronths
betore March 37 oI each year the deduction is swyht Counry Recorder
See reverse side foradditional insfructions andqualdications. GIBSON COUN7Y AUDITOR
P�D�Y �
i�c,r.ar.r„-,;�
see res�ra
L1
Keynumher
Mor(qage /
Mard� 1. a
'7-b3 -300 -c�oo•
unpai0 a d
11 no. what Is his / hu eraa share of intr�t7 I
It rame m reco�d is tlille2nt Nan that o/ appWant, Mdirate balow.
��o� � r3u ��1 AN 3—
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,�� �3 m ,P�,
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a __._. I If yes, what munp?
Y� ❑ Yes ❑ No
What Tadng Districl7
l
Record nur�b�{ I Pag I�� /
I ���
Is tice app�ant tlre sde
legal w epuitable wme(.�
❑ Yes ❑ No
Is ihe property in questian: MnuaDy AaesseE
❑ Rea� afovenv ❑ ��h'. �
Has Nis OedurSon Eeen fequestetl on prape+ty
for werent yeaR �.. �