HomeMy WebLinkAboutMortgage_Bolton � ..r
s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
: :_
FOR DEDUCTION FROM ASSESSED VALUATION
f' State Form 43709 /6-09) FI ED
Prescribed by Department of Loral Government Finance
INSTRUCTIONS: gad
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located AR §O/I I fr
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. rU 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. n/ �,�at+a�YRecorder
See reverse side for additional instructions and qualifications.
t(owner or contract buyer-see restrictions on reverse site) f'IBSON COUNTY AUDITOR
Ta rig District Key number/ I description Record number Page number
/-ry6 . r2-(O — Iq -/ e — /o!- ooh. / 70 - 0 .1- 4, ao <3 S' ;, ?.
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Mash 1,current year March 1,current year date of application legal or equitable owner?
IC? yDDD ❑ Yes ❑ No
If no,what is his av
/her exact share of interest? If owned with someone other than spnmse,indicate with whom
If name on record is different than that of applicant,indicate beouv Is petty in question:Annually Assessed
Real Property ❑Annually Assessed
Mobde Home(IC 6-1.1-7)
Name of mortgagee or contract seller ,
Address of mortgagee or contract sever(number d street,city,slate,and ZIP code)
Name of assignee or other owner or holder of mortgage
Add fassignee(number t.city, a P code)
- � a - c 33
Does
county ap property in other If yes,what county? Taxing District? daducdeduction property been requested on property
„Indiana?
❑ es ❑ No ❑ Yes ❑ No
COUNTY AUDITOR •
Deduction approved in the amount of: m
Drawer NO,,c.9/3 —
20 20 20 20 ,-
`/-� Card 1No. Si 7
Signature of - i��� „4.2til/ .......
Sg .ry rtor County t�l1b•••• ...........
I ,ii.X. JI/We certify under the penalty of perj perjury that the above and fo reg oin g information is true
I
owner!
�/cco^n�tract buyer of the aforemention e dd property on date application is filed.
l9�MmaiC Ys NO ro ) Date(month,day,Year)
F ent a ��t(numher nd street state,and ZIP code) ..t-N Y 767 0
$(J5 (1rpok 2 f- Bra N
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 sweet,city state,and ZIP rode) w
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