HomeMy WebLinkAboutMortgage_Moody (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS - County - Township Year
kit's7.-ii? FOR DEDUCTION FROM ASSESSED VALUATION
Ti-i34.Z State Form 43709(R11/6-09)
- -... ... Prescribed by Department of Load Government Finance la
•SIRUCI7ONS:
I 1.1 ;111g a II
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought.
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)monthsJAN 2 fie frUnty Auditor
GIBSOSEE----N COUNTY AUDITOR
before March 31 of each year the deduction is sought dounty Recorder
See reverse side for additional instructions and qualifications.
'Applicant(owner or contract buyer-see restrictions on re y side)
Ta0District, Key num• ir.i... description Record number Page number
Avvi-e-ern-2 d‘h - / a -18 - Aol - 0 070 )-- es? J3
Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1.current year date of application legal or equitable owner?
1 3/ 0 0 0 0 Yes El No
If in what Is his!her exact share of interest? If rimmed with someone other than souse,Indicate with whom
If name on record Is different than that of applicant.indicate below, Is the property in question:Annually Assessed
Weal Property 0 Annually Assessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller
/
Address of mortgagee or contract selle (number end street,city,state,and ZIP code)
irikt dett-otke---) a- --) 71..e.n.72/-tel.e4
Name of assignee or other owner or holder of mortgage
• •
Address of assignee(%umber , treat,city,state and ZIP code)
gp )-- i S • 1 d-- 17-tvitee_21,—) .
Does applicant own property in any other 7 If yes.what county? What Taxing District? Has this deduction been requested on uated property
county in Indiana? [for area year? _r--1 9 No
Dyes 0 No —- - ___
1111 COUNTY AUDIT i en/ :0 0 af Nat' A
Deduction approved In the amount of. MA/eV .6egrafir;)
20 20 20 20 r,
/3- al OIA
—
Signs County Auditor. ,....cdinitacr.tx." County
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./contract buyer of the aforementioned property on date application is filed.
y\ Stns.-aye(pull jrne)frive. Date(ner417,daY,Year)
\t. Full resident address of applicant(nu end street shy,state,end ZI code)
rin- s 6 .'13s ..— St Ntlecti.4 ..tv (7-'6)0
Person authorized by duly executed Power of Attorney or by IC 6-1.1-1 -0.7 Date(month,day,year)
Address of authorized person (number and sheet,city,state,and ZIP code) .
._ .