HomeMy WebLinkAboutMortgage_Lamey (2) it STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year I
FOR DEDUCTION FROM ASSESSED VALUATION
I I
~ " State Form 43709(R11/6-09) I$I T�gIf
Prescribed by Department of Local Government Finance IFiIBMall
INSTRUCTIONS:
FILED
To be filed in person or by mail Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. /t&1 7 2 1
Must be filed with the County Auditor or County Recordei of the county where the property is located M 12 OoSAty uditor
on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the trijr1fr g
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications. /_"�//
ApWie. (owns w„12cY buyer-se�rasMt_ on reverse side) aot3— 1w /
Taxing District ' 1 /J.`, Key number legal chbcriplbn Rewrd nu b I Pa a number
0We(lSV,1ILO 3yl.-1 1Hee le;–00031d1.(�l/ P I $O.YKa✓5)?CoYfct'I 1�4r9�drr►�°'�r
Assessed value of real property as of Mortgage/Contract indebtedness unpaid at of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1.current year March 1,current year date of ap tication legal or equitable owner?
501'x// 0100 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone&her than spouse,indicate with whom
It name on record is different than that of applicant,indicate below: Is th roperty in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Nam of ?rtgagee or contract se r
; , Thlro( IM a
Address martga or contract eger(num a scree[city,slate,ark ZIP
I n oil- St3a3
Name of assignee or other erw rot mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other 7 If yes,what county? 1 What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
ty ❑ Yes No y ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 I 20_ 20 20_ 20 20 20
•
Signature of County Auditor 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
I owner/contract buyer of the aforementioned property on date application is filed.
. net resit? er's/WI name Date(moot day.year)
1 Jl/ ated
FuOCI••address f appGCar}l,ember and west.yity,state. code) 141/ it-7 ta• (F•J( Ll. Y-WI-/yVl{. /�0/ ii q',ns IVwI
. Person authorize by duty executed Power of Attorney w by IC-6-1.1-12 .7 •7 Date(month,day,year)
• Address of authorized person (number and street.city,slate,and ZIP code)
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