HomeMy WebLinkAboutMortgage_Kent STATEMENT OF MORTGAGE OR CON 1,I ; c County Township Year
FOR DEDUCTION FROM ASSESSED VA L T,• B-1 j�
State Fonn 43709(R11/6-09) I a , i
Prescribed by Department of Local Government Finance
APR 0 A File Mark
INSTRUCTIONS: 2013
To be filed in person or by mad with the County Auditor or County Recorder of the nunty where the property is located. Form tiled
with:
Filing Dates: 1) Real Property.Must file during the year for which the deductio if • ght. County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property ••• n-7idi ij twelve(12)months
before March 31 of each year the deduction is soughGIBSON COUNTY AUDITOR ❑ County Recorder
See reverse side for add— nal instructions and qualifications.
Applicant(owner moon b see restrictions on rse side
p 7 2
`�rCf a•i rwmoer/ ttlegallY'/VI (/ f as- l��-coo.S9'F-Vok) Record romper�J Pie/ Q�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appfirent the sole
Mends 1,parent year March 1,cunenyyearr O O� date of application legal O equitable O
/�_( C Yes No
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 ddferent than that of applicant indicate below- Is the property in question:Annually Assessed
❑Real Properly ❑AnnuallyAssessed
Mobile Flume(IC 6-1.1-7)
Name of mortgagee or contract seller /V_ll,'J/
Address of mortgagee or contract seller(number and street city state,and ZIP code)
Name of assignee corer---
at) �
1
at county? What Taxing District? Has this deduction been requested on property
Draw.Cr 1�••••.� ••• �j2 . .• for current year?
(Z33 ❑ Yes 0 No
Ct)•dNO• ••••••• COUNTY AUDITOR
La 1 210•
tv 20 20 20 20 20 20
-
Signature of Auditor } / I 1 /-a County Data(month,day,year)
I/ e 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.
"Signature hull name) Date(month,day,year)
— f p 'e.4.__ °
F resident address of aapptcant(number and street illy.state,and ZIP code) .
- 3o/ SMtor? itw.v D4 PA70Ala Yh/ 417000
Person authorized by duly exeaRed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city slate,and ZIP code) \�A```
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