HomeMy WebLinkAboutMortgage_Hanson ?„ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
;;, FOR DEDUCTION FROM ASSESSED VALUATION
I" State Form 43709(R11/6-09)
Prescribed by Department f L n cal
Government Finance
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INSTRUCTIONS: 1
Forth Ned with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. l--��A �p,L �yti
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. LYIh1'f'f'Y/`Dq'MY'I'3
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. - ❑ County Recorder
See reverse a for additional instructions and qualifications. lu
w"er°r tract buyer- ere inverse sale) GIBSON COUNTY AUDITOR
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Key ben/leg el, Record number P
(r' . o _/f- a3oa-0 o/ 3,53,-caz G aoi02— 7/7
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mort gage/Contact indebtedness unpaid as of Is the applicant the sole
March 1,=rent year March 1,airrent year date of appfica' legal or equitable olmer?cps
0 Yes 0 No
If no,what is his/her exact share of interest? If owned with/��other�� udimte with whom
If name on record is different than that of applicant,indicate below. (/O \\Is property in question:Annually Assessed
eal Property ❑Annually Assessed
Motile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract suer and street city,sta n�i)�
Name of assignee or other owner or holder of mortgage �C /fi E....74-- //�fg
Address of assignee(number and street,city,slate,and ZIP code) (/' / //a(/
Does applicant own property in any other If yes,what county? at Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20 _
Signature of County Auditor • County _ __ I Date(month,day,year) - ____
I/We certify under the penalty of perjury that the above and foregoing information is true and correct al /-�r�13
owner/contract buyer of N aforementioned property on date application is filed. ot,�
/ Signabue(owners file name)
Drawer NO
Full resident address of a� (rumber and street,cry,state,and ZIP code)
i 1D.9 E. , FDEc S4 RI_ ire rI mtJ Rib Ll Card NO.
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 J'2 t - 3l.1 vv
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Address of authorized person (number and street,wiry,state,and ZIP code)
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