HomeMy WebLinkAboutMortgage_Compton (3)"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS own i r
7 � FOR DEDUCTION FROM ASSESSED VALUATION
� State Fam 93709 (R77 / 6-09)
� 1 p��{p� py pepyn�nt ot Laol Govemment Frunce
� '� `�012
INSTRUCTIONS: F� m� �:
b be filed in person w by maii with the CowryAuditor or Counry Recorder o! the county where tAe property is bcated.
Fi/irg Dates: 1) Real Property Must file during Ute year Por which the deduclion is sought. -�� n ud'rtor
2) Mo6de /Manufaaured Homes �rot assessed as Real Property: Must �ile dunng the hvelve (72J monNs
6ePore Maah 37 of each year Ne deduction is sought. CounN. r
See reverse side (or addifional insfnations and qualifications.
GIBS ❑ NTY A�
Ma��Jownerormntracrbuyer-searew"v�bonsonrevarxside) _
Assess4d vdue oF
Ma�d� 1. aarent N
�i M. W�12� 6 �16 i�IC! BTdf�
-
hWebtetlness unpaid as d Is ihe eppfirant Ne u
tlate ot aoP�� iepal or �quitade owr
If owned with someone other Ihan spaae.
pmpeny in VuesGm: M�wwalty Assessed
eal ProPertY ❑ Nmualiy Assessed
Modle Hane OC 6
6
VJhat Ta�dn9 Disbict? Haa ih's Aetlurtion Ecen re9ursted m
brartent�_�- --s
� 5-f�Ut� G -
�mP'fl7t�� �p m -
C�lss�P``� -
2�
. � �- 3`�3 -
No
I/ We certify under ihe penalry of perjury that the above antl foregoing intorm�._... ��� � ue and cortec[ arM Nat ihe appiirant is a resident of IrMiana aiM
owner I contrad buyer of the aforemerrtirned property on date application is filed. �
7nahue (awnefg lull name) ���-T I i � I�/ �- •\ Dale (nrnfi. daY. Ye�
�" D� n �.n,i�e-n.�� (1'� �
�� � a� s�o=is w 4 ti"�`e, Bc,�em�,�.St.9.� � 4��los �
NAttamey or by IC 67.i42-0.7
Person (num0er antl sneeG dN. s7afe. aM
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