HomeMy WebLinkAboutMortgage_Deputy (2) STATEMENT OF MORTGAGE OR CON fl County Township Year
MA. FOR DEDUCTION FROM ASSESSED VA 77J�LOO
State Forth 43709(R11/6-09)
Prescribed by Department of Loral Government Finance
INSTRUCTIONS:
MAR 13 2013 File Mark
Form filed wph:
To be filed in person or by mail with the County Auditor or County Recorder of the unty where the pm is located. IL'filed
Filing Dates: 1) Real Property Must file during the year for which the deduction ough County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property: verve(12)months
before March 31 of each year the deduction is sought.GiBSON COUNTY AUDITOR ❑ County Recorder
See reverse side for additional instructions and qualifications.
Appfxam(ownero contra buyer-see ns on reverse side) iv
T ' Distri ,gab-aoo - coo. 03 -0010 P ebb
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,w t y r e �• date of application legal or equitade owner?
5` girg1 ,pJ El Yes 0 N
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 applicant,indicate below. Is the property in question:Annually Assessed
❑Real Properly ❑Annualy Assessed
Mobde Home(IC 6-1.1-7)
Name of mortgagee or contract seller - - -
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) - -
•
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.coy,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of -
20 20 20 20 20 20 20
Signature of County Auditor I 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./contract buyer of the aforementioned properly on date application is filed. - --
Sig �y(owners full na/mfe) r� . ) Date(month,day,year)
resident t(number a &beet. ,state,and code) //J
a b a�- S S R s'i oa.lata ni CL. •41n1-114400 -
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,dry,state,and ZIP code) • _`,`