HomeMy WebLinkAboutMortgage_Rumble STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
�f- , FOR DEDUCTION FROM ASSESSED VALUATION jJ f.x 'D
state Form 43709(R11/6-09)
"� presaibed by Department of Local Government Finance
File Mark
likTRUCT7ONS: JAN 2 • :adwh:
To be filed in person or by mail with the CounryAtMitor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought A County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)m, i s • ,
before March 31 of each year the deduction is sought I•, gr>nj�!� County Recorder
GIBSON COUN - • . • • -
See reverse side for additional instructions and qualifications. �� �0,yfnl,y
Applicant a n D(owrraryrpQrrtract use( VV 1" ��) ��/' w .
TaxiM D-, Key . •-, /legal d—.'•ton / Record number
/alla Le is _ - . -0 : -..... .O -s• - . - 1-oaif . a/
—!S•a :of real property as of /Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Marctr �. - year M
ate: date of application legal or equitable awneR
.�V.JI,hV)L /VV�JV� ❑ Yes ❑ No
If no,what Is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name on record S different than that of applicant,Indicate below. Is the property in question:AnnuallyAssessed
❑Real Property ❑Annually Assessed
Mobile Home pC 61.1-7)
Name of mortgagee or contract seller
UffnIAACelven
Address of mortgagee or contract seller(number and street,spy,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city.state,and ZIP code)
Does applicant own property in any other • If yes,what county? What Tardng District? Has this deduction been requested on property
county in Indiana? ❑ Yes '❑ No for current year? ❑ Yes ❑ No
_________
//.[� - COUNTY AUDITOR
Deduction approved ' IUiT'i —;_ ,late; M^ '
20 1-44' fl HA _ 20 20 20
r/tJ J J
Signature of Count /3 ^7 j r A i County Date(month,day,year)
I/We certify•_.._ (}f{ nation is true and correct and that the applicant is a resident of Indiana and
owner/con'- buyer of the atorer,R..__.. _ :filed.
Sig•-1we(o 1
`dr ess of a m e)�
Date(month,day,)ear)
//25/20
e
( u mberand t dl1 stff,and LP coe) a #r0 CO L S G2�u.oter
• 14a449/- 4 76 35
Person authored by duly eiecoad Power of Attorney or by IC 6-1.1-12-0.7 Date(month.day,year)
Address of authaacM person (number and street city,state,and ZIP code) .