HomeMy WebLinkAboutMortgage_Leukhardt STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,;; FOR DEDUCTION FROM ASSESSED VALUATION
70.4 . 'l State Form 43709(R11/6-09)
'tc'''^" Pr soibed by Department of Local Government Finance
LIL
INSTRUCTIONS: Hggy�t�
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. F M17/-1(( 1 4 2013
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought. I__ County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought. Gaon a r�
See reverse side for additional instructions and qualifications.
Applicant(o : or cenoad buyer-sqe re-.' on reverse side) / / GBSON COUNTY C(JnmO�
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T.: % // Key .. /leg/esai "' Record number Page number
�'i i (/r/C/i „ , - .. - , - 0?Oo-000.a6/-6ol 5e f OJS /dV2 .
• _,.value of real property as of /Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the apprrrant the sole
Ir • 1,current year Mar rcurrent year date of application 9 / �/ legal or equitable owner?dj(j��(CO 0 Yes 0 No
If no,what is his I 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 property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller .
4/126
Address of mortgagee or contract seller(number and street coy/¢ate-and VP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,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 yew ❑ Yes ❑ No
COUNTY AUDITOR I-j U K MA Qp r Kt'12.R-ty —
Dedur9on approved N the amount of
Ai A-00-11 g
20 20 20 20 . ,�,1/
Signature of County Auditor County /3^ /✓r `f() , -
I/We certify under the penalty of perjury that the above and foregoing information is true anc _ . ...............�.o,n e„�
owner I contract buyer of the aforementioned property on date application is filed.
, re(owner's fug na ) Date(month,day,year)
b�2cdah eif1,a t /p ,y Q yn^' 1/!y/ /�
/ Full resl�ent ad D (number fi e:end ZlPmde /1.1z(/r, mil- -T-7/ e C/
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Person authorized by duty executed Power of Attorney or by 1d g-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and serest city state,and ZIP code)