HomeMy WebLinkAboutMortgage_Mossberger C e _ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
: FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
prescribed by Department of Local Government Finance f II_ j
Fil it•STRUCTIONS: I
To be filed in person or mail with the Court Auditor or County Recorder of the county where the properly Form filed with:
P by County h ty P Pertl'is totaled.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. n�� 1 p 1 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)rrmnme 1.8 201P,
ry
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications. IIIr
Applicant(ow eror contact buyer-see restrictions on reverse side) tr 9'r1P.
GIBSON COUNTY AUDITOR
T -till District ' Key number/legal description Record number Page tuber
As -c47 2,(0 18 -�0 - goo -ooa, 290 _ o � S q- 0 o into
P value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
no ODD ❑ Yes 0 N
If no,what Is his/her exact share of interest? If owned with someone other than spduse,indicate with whom
If name on record is different than that of applicant indite below: �Iss th�ee °pert N question:Annually Assessed
L �Propy El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 376
Address of mortgagee or contract seller(number and^ 4 ray,stare,and ZIP code) .
Name of assignee or other owner or holder of mortgage
Address of a41 (number and street,city,state,and 1 l Li -too A- C
Does applicaaIn"tt own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for armed year?
❑ Yes ❑ No ❑ Yes ❑ No
0 COUNTY AUDITOR __
Deduction approved In the amount of:
20 20 20 20 O k D
Signature or ty Auditor _ County Drawer NO _
I/We certify under the penalty of perjury that the above and foregoing Information is true Card NO.
owner I contract buyer of the aforementioned property on date application is filed.
*nag/owner's MI name) uate(morn,day,year)
/AAs of T ,t .., I
Full resident address of applicant(number nd street,thy,staVand ZIP code)
A 559L1 w ?OO S OA)enrv) /I-e1 /N y7(i(os .
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,end ZIP code)