HomeMy WebLinkAboutMortgage_Birch STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
:: FOR DEDUCTION FROM ASSESSED VALUATION
Y•'• State Form 43709(R11/6.09)
Prescribed by Department of Local Govemmerd Frhama �i III
1 Fi h
•VSTRUCTIONS:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is local 1 Form filed '
Filing Dates: 1) Real Property.Must tile during the year for which the deduction is sought. NAY 1Z County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months L'I
before March 31 of each year the deduction is sought. C (.rte ..d-1 ounry Recorder
See reverse side for additional instructions and qualifications. �\\l
App&ant(owner or. :.buyer-see restrimaylmre ide� GIBSON COUN
. • S
Taxi t- _IKado-rig-Qa- two - 00o . 3 Ll'7—oas 12etord thi Page number
Assesssseydd value of real property as of /Contract indebtedness unpaid as of Mina ,. _. t indebtedness unpaid as of Is the apprrant the sole
Math 1,on Year F1arrh 1,�rtept ye9r I date of applkation gal w agWtaNe owneR
1/C_ 9 ❑ Yes ❑ No
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. _ _ __I Is the property in question:Annually Assessed
Name of mortgagee or contrail seller
Address of mortgagee or contract seller(number and=vet city.state,and ZIIIPP /code)
tetyceir) _
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? NTat Taxing C S./ a 0 I ^y a+' I /9
5 7
county in Indiana? ❑ Yes ❑ No
® COUNTY AUDITOR '1 ��/� C
Deduction approved in the amount of: y� 11 Q 7 Y Y 1 / _
-W1 (D 1r�M./ Q
20 20 20 20 CS1.Computer Systems, Inc.
866-913-4160
Signature of County Auditor County _
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/contract buyer of the aforementioned property on date application is filed.
nature(o ert rut rams) Data(month,day,year)
F r ent address of applicant(number and street,lily,sta ,and ZIP Fad Rv / �� 9:7C y P sorA
P a ' by duty executed Power of Attorney or by 6-1.1-12-0.7 -n_(_f(`1 Date(month,day,year)
Address of authorized person (number and street,city state,and ZIP code) .