HomeMy WebLinkAboutMortgage_Priest^'� STATEMENT OF MORTGAGE OR CONTRACT INDEBiEDNESS Coun Township Year
; FOR DEDUCTION FROM ASSESSED VALUA� ��
State Fartn 43709 (R71 / 6-09)
•S f p��bed M DeG�eM af Local Govemment Firence
File Mark
wsrnucnoNS: JAN � 2013 Fa,�,mm�,:
To be filed in person w by mad with !he CounlyAWitor or Counry Recorder o/ Ne county where the property is located.
Fding Da[es: 7J Real Pmperty: Must file dunrg the year for which tha deduction is so_ hyr��� , r ty �Counry Audmr
2) Mo6Be / Manulactured Homes rrot assessed as Real Ploperty: Must � unng t e{f2J'months
before March 31 of each year the deduclion is scuight - � ❑ County Recorder
Seereversesideforadtlitionalinstructionsandqualifications. GIBSONCOUNTYAUDITOR
AooGmnt (o�mer w conlraC 6 2s7+ir�ePS m reYKSe �
' /a-�7�3—Cp�_ �ll-o� �b�,3 P
vl iMehteEness unpaitl az of Mortgage / Canvact'vde6tedness unPaid as d Is Ihe aPPGrant Ne sole
xar date of aPPOcatbn �gal w eWita6le ameYJ
�%� n Yes ❑ No
It �w, wfiat Is his ! her e� st�ara ol mteresP!
it name m �emrd's Nfterent Vun Nat of aPP�t'utl'¢ate bebw.
� c�t ��
Name N moR8a9ee w mnttaG seper
Address of mort9a9ee ar contraq
�a�����o��
A4C�ess
��.
stree4 �: �e, ard LP code)
H owned win someone other Ihan spousa, indicate Wth whom
Is Ue Property in quesaan:
❑ Real Property ❑ P
8,��'+ fl' �.`�'°}
D ��:��, ��- � o.. c.��..�. � 3.......
Dces ePPlinnt own property in any oNer If yes. what coun� /� .1 . g]� been rW ueste0 on P�nY
oounry in Indmra? ❑ Yes ❑ No l. il l� LL�i 0. ... �� ❑ No
............... ❑ Yes_