HomeMy WebLinkAboutMortgage_Blankenberger (6) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709(R11/6-09)
'i Prescribed by Department of Loral Government Finance
FI ile
INSTRUCTIONS: €
Form Dad with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: I) Real Property.Must tile during the year for which the deduction is sought. A"R Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months b
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications. I, /7Y'j//-
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r/rylm [I�/aI `(s�PJvieo)n(,!�/y) y ,'{ (_�/� GIBSON COUNTY AUDITOR
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Assessed vat of real pruperyy as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid/ as of is the applicant the sole
March 1,=era year Marts 1,wmat year date of apPlcaUc .Q0 legal ❑equitable❑owner?
lL((�)�(( Yes No
If no,what is his I her exact share of interest? If owned with someone other than pouse,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
1/4:111.26011 g( a (IC 61.1-7)
Name of mortgagee or contract seder
Address of mortgagee or contract seller(number and st and ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street cdy,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 anent yea?
❑ Yes ❑ No
^MINTY AUDITOR
Deduction approved in the amount oft ___
20 20 20 20
Drawer NO.. a31 3
Signature of County Auditor . • ......,,' i(month,day,year)
Card
I/We certify under the penalty of perjury that the above: 1\O. , I ant is a resident of Indiana and
owner I contract buyer of the aforementioned property or RC '''•••.
Signature(owners or name) �y V J I(M \ •••••••• rte(month,daY.year)
till resident address of applicant(number and street rill:state,and ZIP...:)
1\ ' Sorb 6 R .S S Foci Zcc‘Ach to 4764%
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .