HomeMy WebLinkAboutMortgage_Davis (11) f° .. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
•rr^ j; State Form 43709(R11/6-09)
Prescribed by Department of Loral Government Finance 7
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INSTRUCTIONS: Fil ��I al
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lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form filed with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought rF�1r town don
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months �f 1 L Vito(
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before March 31 of each year the deduction is sought. ❑ County Recorder
See reverse side for additional instructions and qualifications.
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Applicant(o�yr �contract buyu-seerb'ons orr r�v�se side) GIBSON COUNTY L/) TJy6� Key number rle� ot lon OUNTY AUDITOR
TanngD aG //d-�J °o� 00/. 4Z' 4 -Oa? Record number Page
Assessed value of real property as of {IIMortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the approant the sole
March 1,current year 1 7,anent year date of app/' t(oq 65 pp I ❑ Yes e❑ oN
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. Is iqe property in question:Mnualy Assessed
Real Properly ❑Annually Assessed
Mobde Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street cal: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 Taxing District? Ias this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current year? ❑ No
❑ Yes
COUNTY AUDITOR
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 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 :.ct buyer of the aforementioned property on date application is filed.
Slg .. ! het Date(month,day,year)
yr.
,f/� Full ,—'...nent:.. _ ... .. t(num rr and street city.state,and ZIP e) r�
t / rl'`I 0 it E' / 4 n el- % /'i-7 /.'c ter c#-, /'N y 7G 9c
c - • authorized by duly executed 6 .r of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street citty,state,and ZIP code) .