HomeMy WebLinkAboutMortgage_Genung ..„„z±,,„; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;,: FOR DEDUCTION FROM ASSESSED VALUATION
,-c}--" State Form 43709(R11/6-09) -
S`, Prescibed by Department of LOW Government Finance
®INSTRUCTIONS: Fyrta
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. FC p 1 filed gn 3
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought l[] County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought � . er
See reverse side for additional instructions and qualifications. GIBBON (;()LINT
Appricont( or contract buyer-see reverse side) Y AUDITOR
Taxiag Dismri Key number/Ie9aI description Record number Page number
At-. -/e-13 - (fool - 000, 755 - C J. , ' 3 48 Y
Assessed value of real property as of =ace/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is due app�t the sole
Mann 1,anent year Marrh 1,arrtent year date of application legal ar equitable avme(!
42 Cc7 � ❑ Yes 0 No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
•
If name on record Is different than that of appecant,Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑MnuallyAssessed
Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller
Address of rtgagee or contract seller(r.r. j3nd street,ry w and ZIP code) _ _
Name of assignee or other owner or holder of mortgage 1 AA�'�.C/V�/ �� ,6 M/ ' N J_1 _-
Address of assignee(number and street,dry.state,and ZIP code) l( L,.j/R
Does applicant own property in any other If yes,what county? ' What Taxing' 13_ / (J y —
county in Indiana? ❑ Yes
❑ No _
® COUNTY AUDITOR _
•
Deduction approved In the amount of:
20 20_ 20 20 20 20 20
Signature County Auditor • , County Date(month,day,year)
,/-` ,
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
/`(, Signature,Aawrre me _y W`mow a Date(month,day,yaw)
.1.4
Full resident address of applicant(number and street,cdy,state,and ZIP code) D /
X / v 1r 'S I S)NGL4112 S,' , I:-D + pfOh&hf 1- '-1' lq&
Person authorized by duty 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,and ZIP code) .