HomeMy WebLinkAboutMortgage_Bugher (2) f s'_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTED � c !n Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
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,z'"" State Form 43709(R71/6-09)
�K;- Prescribed by Department of Local Government Finance
INSTRUCTIONS:
MAR 14 2013 File Mark
Form filed'Li""'with:
To /
be filed in person or by mad with the County or County Recorder of the county where the pro rty is located.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. uMy Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the n
before March 31 of each year the deduction is sought. GIBSON COUNTY AUDIO County Recorder
See reverse side for dditional instructions and qualifications.
Appfuarn(o ct buytir^eee restrn;t`.vis on re e) /1 a 7 (/�/�{ /J
T strxt
"iv Key % /legal desai �r�I//II.nV, \Lt'/, �7�LK^�/�L_ Record n Page number
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Assessed value of real• •,•> as of Mortgage/ indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as ot Is the app0onl the sole
March 1,anent year Mardi 1,a date of application legal w equitable ownery
_. a o0 ❑ Yes ❑ No
tf no,what is his/her exact share of interest? p If owned with someone other than spouse,indicate with whom
If name an read is different than that of applicant.indicate below. Is the
property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile 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,oily;slate,and ZIP code)
Does applicant own prom-'-'— / V that county? What Taxing District? Has this deduction been requested on property
county�atr.r A O,j u rt( for current year?
�"" r �Jll ❑ Yes ❑ Na
bUGI4b jU COUNTY AUDITOR
13- I C\ 20 20 20 20
_i
Sy County Date(month,day,year)
ii 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 I contract buyer of the aforementioned property on date application is filed.
re(owner's lull name) Date(rtonth,day,year)
WI.
g rest a addressss of appfmant(nu. bet and sheet,tray,state,and ZIP code
Q438 N��i1� Solent �anel �az) c4z�n1I1�' ��(.
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0. Date(month,day,year)
Address of authorized person (number and street ray,state.and ZIP code) ki*\