HomeMy WebLinkAboutMortgage_Green (7)^'�a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co � Year
^�_ _ s FOR DEDUCTION FROM ASSESSED VALUATION
.• State Fortn 43709 (R71/6-09) J N 7 20��
�' � P�esrnbed tY OeP��ent af Local Govemment Framx
File Mark
INSTRUCTIONS:
To 6e filed in person or by mail with the CountyAUditor or Counry Recorder o! �he cnunty where the property is bcated. ,�,.,...uuvrrrv.v���p p
Fd'ug Dates: 1) Real Pmperty Must file dunng the yearlo� which the deduclion is soughG GIBSON CO��y����joR
2) Mobi7e /h4anufacNred Homes rrot assessed as Real Ploperty: Must file durrng fhe hvelve (12) months
before March 31 of each year the deducfion is soughG Couniy Recorder
See reverse side for additional inshucthns a�M qualificafions. �
�etl rann m rral paper:y as
1. av�ent year
Key number 1 k9al desai0�n' �� / W/ / � �� Remrtl numbu Page nuMer
(O
at Mortgage/ Contract NtlehleLness unpaid az of Mongage / Con:raG InEe unpaid as d Is the app�'ant We
Mard� t. Yeer tlate of aPPOfation �gal w eWitable awnrYl
❑ Yes ❑ No
of interesi? tt wmed with someane oUwllhan spmae, udimte WM wlwm
If nazne on femd is Ntlerent itwi ihat of aPP��L �difate Eelow.
Name af mortBa9ee or
Address of mortgagee w wntraG seller (number
w amei awnu ar nawer ot rtwrtgage
ot amgnee (numcer am suee; ary, s�e, ano cir cooe7
ooes appP,
mu�
DeEuction
20 _
Syr�a¢rte
P�P�Y in anY other � tt Y�. what countyt
20 I 20 I 20
Caunry
Is Ihe Praperty in Ques6on: MnuellyPSSessed
� REaI Roperty ❑ PN1U20y Pssessed
�%t4.ti� CAILCI.yr� S
/� -� v�y
�_
20 _
Date (rtwitl+. daY. Yea�
Y
TO _
I/ We certify under ihe penaliy of perjury that the above and foregoing infortna0on is W e and cortect and that Ne appiipnt is a resident of IrM'2na afd
owner I contract buyer of the aforemerrtioned pmPerty on date applicatlon is filed.
iC
of aulhor'¢ed prlson (numDera�N sneeL dty. slate, and LP code)