HomeMy WebLinkAboutMortgage_Gilliland"'n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou wn Year
_. • FOR DEDUCTION FROM ASSESSED VALUATION
- � State Fwm 43709 (R71 / 6-09)
4' ,,,, � presrnbed by �epaN�rent of Lacal Govertu�rent Fnarze F
INSTRUCT70NS: �AIV�� `�Z013
To 6e fiied in person or by maB wrth the Co�ntyAuditor or Counry Recorder ol the county where the property is located. Fam mea with:
Fifing Dates: 7) Real Pmperty: Must hle during the yrear /or which the deducUon is sought. � �
2) Mobile / Manufacfured Homes not assessed as Real Property. Must fiIe dunng the hveHe (12) months g
6efore Ma/ch 31 of each year the deduclion is soughG ('i 185� C N U�r
See reverse side for adtlitional instructions and qualificatbns.
I MP��� �owner oymntrjft buygr'see restricfions m reyrrm side) /1� w A�. n .
Key numE� legal desaiG�n
aareld year
tt no, what ts his / her eract share ot
It name m remrd'a 6flernnt Uan that of appGCant, Wirate Eebw.
Nart�e ot rtnrtgagee v conNaG se�er � 1
1
L
AEdress of rtwt�agee w contract se0er (nwnbe� anE sC
Name of essignee or other owner or hdder of mortgage
Address of asvgnee (number arnd stree4 �1; state, erq
Does ePpfimnt own pmperty in any other
counry m IrWFdr�a?
❑ Yes ❑ No
Deduction aooroved'u� the artmuni of:
�
SigreIIea d Co�mb Audimr
0
stafe, arrd ZIP coda)
of IMongage / ConTacl
tlate of appGmt6n
1
Remrd numbu
es d 6 Ne appGant Ne sole
kgal w eq�dtaWe ameR
❑ Yes ❑ No
klih whom
Is ihe G�P�Y in questx
� Real PfoPenY ❑
��Y jur.ot0�y �. �`4S�`�cl� �
DI'1\1'Cl" ��..`!;O!�........ rc
zo
Car(1 NO. ....Q.�!.:o't..........
Counry
�
0.5sessed
ome fIC 61.
zo
P��Y
❑ No
I I We certify under Ne penatty of perjury Nat the above and foregoing information is W e and correct ar�d that Ne applicant is a resideni of IrMiana aM
owner / mntrad buyer of Ne aforementioned property on date appficatlon is filed.
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smte,
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person (numberaiMSbce4�fi:slaM,a�LPCOde)
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