HomeMy WebLinkAboutMortgage_Jackson (2)^'na STATEMENT OF MORTGAGE OR CONTRA��� oun Tovmship vear
a FOR DEDUCTION FROM ASSESSED VALU
� ... �• Sfdte Fortn 93709 (R71 / 6-09) 8
�' �«. ° Presrnbetl bN DeP�ment af Laal Covemmei# Fi�nre
lNSTRUCTIONS:
DEC 2 S 2012 Fle Mark
Fortn Aed with:
To be filed in person or by mad with the CountyAuditor orCounry Reco�der of the coupry, peRy is located.
Filirg Dates: 1) Real PmpeRy: Must fi1e duriig the year /or which the deduction is sobg �, Counry Audimr
2) Mo6de / ManuFactured Homes rrot assessed as Real Property: Must file dunng th (12) rtronths
befaeMarch3lofeachyearNedeductioniss�uyht GIBSONCOUNTYAUDITOR ❑ �uniyRecwder
See reversa side for additiunal in5tlucGons end qualiflcat'ans.
Am�sed vahie of nal ptoppty az of
Merfh 7, ac�ent yeer
I( ro, wfial is his I hef emG share OI interesi?
If nalne on
rtwrtgagee w mntraa se0er
x/ kgal desmption • Rem�d number Page wmbrs
_ �'7� _�pC�.-Ob U.d� q-0 d a. �'� (01l
'� Mo�ge / Contraa 4dehtedness unpaid as of Mwigaga I Contract Mdebtedness unpaid as d Is �he eppGrant ihe sola
'�, Ma 7, artent yeer date o( aPP�� legal or equitable oN+�eR
' �Q�� ❑ Yes ❑ No
rc owned wi� someofre oNar than soo�. Gdkate Wrth xTam
w mntracl seAer (nunbrl end streeR uty, slate.
ol�„��,� �o: �°! a.......:
'�ff��� .....
c:�l�a ��� � 3pV�• pO�
�_ � �—
1/ We certify under the penatty
rnmer f mntracl buyer of ihe a1
�_
Ihat ihe a
ned ProP KY n date
WhatTa�o(g District7
COUNTYAUOROR
20 _ 20 _
Caunty
F msidEfit ed&es of appGCant (num6e� and streeG �Y te, enA LP mCe)
�0 30 / /U !YI � .
Pe15on auGwrrsetl by duly executed Power of Aimmey or �y IC G7.1-12-0.7
Addres af auUrof'sW person (number antl sbeet uN, state, arM LP mde)
Is ihe praperty in quns�an: MnuaM Assessed
❑ Rea� ProaeM O aamua�y wssessed
Has �his deduction 6een re9ueste0 m P��Y
tar armnt yea(.+ ❑ Yes ❑
Fi�]
Date (nanth,
20
infortnatirn is W e end corteG and ihat the applirant is a resident of Indwu aM
ion is filed.
Date (month, day, y9a�
(monrh. daY• Y��)