HomeMy WebLinkAboutMortgage_Mays (2) s STATEMENT OF MORTGAGE OR CONTRACT I Ili g� rsa.unty Township Year
FOR DEDUCTION FROM ASSESSED VALUATI r1 • 1
;5 State Form 43709(R11/6-09) F J I'
c Prescribed by Department of Local Government Finance
INSTRUCTIONS:
MAR 2-2-2013 File Mark
To be filed in person or by mail with the County Auditor or County Recorder of the county ere the prope r is I. • S. Form filed with:•Filing Dates: 1) Real Property:Must file during the year for which the deduction is
ust file 1 r''•+ =ii 4' 2 months S County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property: - l
before March 31 of each year the deduction is sought. G I BSON C•UNTY A D ITO R ❑ County Recorder
See reverse side itanal instructions a Ifications.
Appfxant(• vyu-instructions
vp�a a
I1/? 40 /— b00 •070 -p/7 (e ) loricl B$Record
Assessed sift_of - property as of tract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Marsh 1.carom �. 71�A`r !�Y date of application legal or equitable owneR
VO a0 Yes ❑ No
If no,what is his/her exact sham of interest? / If owned with someone other than spouse,indicate With whom
If name on record is different than that of appd ant.Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Name of mortgagee or contract seller Mobile Home(IC 6-1.1-7)
Address of mortgagee or contract seder(nrwnber e 'U};sloe,and ZIP code)
Name of assignee or other owner or holder of mortgage
DN
{. _C.._
nr 1 n y s+C `+`C W G 0 mty? What Taxing District? Has this deduction been
requested on property
cou for current yeah
--- '� la1 ❑ Yes ❑ No
8 �
COUNTY AUDITOR
Der
20 20 20 20 to
Signature ot� I / / . County Date(month,day,year)
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 I contract buyer of the aforementioned property on date application is filed.
Signature(o hfl name) Date(month,day,year)
� CXra e�1 ctrl nd
resident W applicant(number and street,city,state,and ZIP code)
, 7o 71 N . Mt KO n Road H/�zlekrn .�Ntf164'O
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 f Date(month,day,year)
Address of authorized person (number and street d0:stare.and ZIP code)