HomeMy WebLinkAboutMortgage_Teel^'3 STATEMENT OF MORTGAGE OR CONTRACT INDEBiEDNESS Coun 7ownship Year
__ _• FOR DEDUCTION FROM ASSESSED VALUATi� ���
.• S1ate Fartn 43709 (R71/6-09)
�' y,� � Resaibed by �eP�meM of Local Govemment Fnaxe
File Mark
INSTRUC710NS: I/�AI a Form Aed with:
To 6e fi/ed in person a by mail wiN the CounryAWitw or County Recorder af fhe county w�Y�'�th�pro�.t bcated.
Fr7mg Dates: i) Real Proper(y Must file dunrg Me year (or which fhe deduclion is soughL � Counry Audimr
2) Mo6�7e / ManuFac[ured Homes irot assessed as Real Ploperty: Must Ae dcyq�g the h Ive s � Counry Recorder
befoie March 31 of each year the deduction is sought .�L�
Seereversesideloradditionalinstructnonsandqualifications. GIBSONCOUNTY�AUDITOR
APPI'�nt(owne�pr cfbuYel"se►resvmll°ns4^f9verse�eCe�-� f. fl " "
B` ' KeY-rumiber / Ieg�A dewiPtim / � ( , ���' `r'--" / RecoN numhrl P`7 /� �
� J/
r
�d rdue of mal � a5 Mortgag e�/ C�o�ntryapG �iM�ehtedr�s unpaid as N Mortgaqe / ContrarY mdebteOness unpaid as of Is �he aPP��I Ne sale
1.aamnYear Marchl. /: XO(� dateofaPPfi�tm � ❑YPSeQ
ts h's / her e�G share of interrst?
If name df remrd
Nart�e o( rrior�agee ar mntraG seUer
rtprtgagee w mnbaG se➢er (nimbe� arid sLee4 �: sbte. arrd ZIP mde)
or oihrl wmer w twlder of mortgaga
Aearess or amgnee
Is ihe vroperty in purstion: Mnualy Assessed
❑ Real Property ❑ Mnually Auessed
Does aPplitant wm property in any other 1-1 If yes, what munt�R What Ta�dn9 �'strict? Has ihis deduction Deen reQuested an p(operty
rollnty1l11fId0�197 n Vx I I Nn (OIWIfEf11YP2h
n Yes ❑ No