HomeMy WebLinkAboutMortgage_Hadleyi` �p� STATEMENT OF MORTGAGE OR CONTRACT INGEBTEDNESS
i'�; FOR DEDUCTION FROM ASSESSED VALUATION. Count Township Year
°;'��`.:"�'.:3f°:"'•. • ' '1 :
.`�j• S�ateForm43709 (R6l5-O6) '��.. • ..
�� Prescribed by �epartmenl of �opl Grnemment Finance -" ' �
INSTRUCTIONS: SEP j Q Z���Mark -�
To 6e filed in pe�son or by mail with the CountyAuditor of the county where the propeRy is locafed.
Filing Dates: 1) Real P�operty: Dunng the 12 months before dune 11 0! the yea� the deduction is to 6� ctive
2) Mobile Homes assessed unde� IC 6-1.1-7: Between January 15 and March 2 0/ the year t� ��n is to be elfective.
See reverse side for additional instnictions and qualifications. ��- " G�BSON COUN7Y q�pITOR
contracf
Distrid
on reverse side)
Key nu ib r/Tegal description I Record number � Ov �
� a�-ia-��-ao�-o0.3.�'i�-da agenumber � �
Assessed value of real properiy as of Mortgage / Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, currenl year March 1, current year owne(? �es 0 No '
�-I 3 (� d d ,-- ---- --,
If no, what is his�/ her exad share of interest? If owned with someone other than spouse, indicale with whom. •
� �- - j )
, , ` ',•'
- t
If name on record is different than ihat of applicant, indicate betow: ' Is the property in question:
r
� eal Pmperty ❑ Mobile Hmie (IC Cr1.1-�
�me of moAgagee or contraIX,�ellern �-
( V i
Address of moAgagee or contractdseller (number and street�ity, state, ZIP
assignee or other owner or holder oi mortgage
Address of assignee (numberand street, city, sfate, ZIP
Does applicant own property in any other I If yes, what county?
county in Indiana?
� `J C� � a �
Dedudion approved in the amounf of:
20 _� 20 �
� A
Signature
. �:
Dra �i-er r�r� �� _
Wh_�/�„/�'�rdl�r� ••� .
�,.���.�� .
.. . �6pp�'
AUDITOR
20 20 20_
County Auditor
20
Date
20
9
:sted on
res ❑ No
We certify under the penalty of peryury that the above and foregoing informalion is true and correct and thal the applicanls was / were
esident of Indiana and owner of the aforementioned property on March 1, 20
nature (owners /ull name) Person authorized by duly executed Power of Attorney
� . _ ` /). �_ %�� , or by IC 6-7.1-12-.07 .
ent atltl s of applicant f dress ot authorized
1
5 ���.�„ �_n_ ��� �._ _. o = .