HomeMy WebLinkAboutMortgage_Head�"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C ' T� Year
-i� FOR DEDUCTION FROM ASSESSED VALUATION I
�'� � Siate Fortn d3709 (R70 /11-OB)
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� Presuibetl by DepaMient ot Lacal Govemmem Financa
wsrRUCnoNS: FEB `��lZ�3$
To 6e !led in person or by mail wifh the CountyAuditor ol (he county where the property is locafed.
Fi/ing Dates: i) Real Property: Musf file dunng fhe year tor which !he deduclion is sought. n'
2) Mobile /Manu7ac(u2d Homes not assessetl as Real Property: Must file tlunng the twefve (72) montlW y(�fE� each year
[6e deduction is sought �'��
GIBSON COUNTY qUDITOR
See reverse side !or additional instruclions and qualifications.
A plicant (owner or mnUact buyer - se6 resfricfions on raverse side)
L. '$�• a- ',t `M �
Tadng Districc Key number/ legal tlesmption Record numCer Paga n��pbQJ�Utl? '
aLV' d.0' / � 0 O 0— 00 lU1sUp1A'
Assessed vahre ot mal p rty as ol Mortgage / Cantraa i�Mebtadness unpai0 as of Mortga9e / Contrad indebiedness unpaid as of Is Ne appticant Ne sda
March 1. arrent year MafcMi 1, wrtent year Ca[e of appficatlon I legal orr e�q�itaWe ovme/?
u Yes ❑ No
It no, what is Ns / �er ezaa share o/ interest? I If owneE wi� wmeone other ihan spousa, inEZate wi� whom
If name on record is diP,erent ihan ihat o( apptican4 �iwte bebw: Is N perty in question: AnnuaOy Assessed
Real Property ❑ MnualyAssessed
Mobile Home QC F.1.7-�
Name of nwrtgagea or conVad seller
F:�1�'h.r�. �.u�-��v_o. �—
AOOress oi mortgagee or mntracl seAer (number and 5 crty. state, arM ZIP catle)
Suo\ Y.�..�.b\c.y p r-• Cc�.� �,�..�, u� �Sa��-?
Name of assignee or o:he er w Mker ol mor(gage
AEdress ol assgnee (number and s1reeL city, sfate, an0
Dces appliwnt own property in any other It yes, what counryl VJhat T�ing DisVia? Has Ws deduction been repuested on Properry I
counry In Intlana? I--I NO far wrtent yeaY! � NO
n Yes ❑ Yes