HomeMy WebLinkAboutMortgage_Hanson tea . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION
.t State Form 43709(R11/6-09) I
C.7±9. Prescribed Department F I II r1, D
by par went of Laval Government Finance �L iLLJ
INSTRUCTIONS:
To be filed in person or by mail with the Court Auditor or Court Recorder of the county where the property Fay fl� -
Filing Dates: 1) Real Property Must file during the b �' P Perry is located.
ng year for which the
ro Property: is sought A R 9: _gfJ y Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:: d Must file during the twelve(12)months
before March 31 of each year the deduction is sought. - ❑ County Recorder
See reverse e for additional instructions and qualifications.
Applicant nor.. ...buye se,1r ° ° on reverse e) GIBSON COUNTY AUDITOR•Ta. /D' �%7/ / J / 1 Ke berr/ destto,ipt(�/rt. �j �J umber Pag9lrym
,- t i a 6--/ (7f T-cio -Oct/. 3.a t0 -62,74 o�3 77
'veresnd value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year March 1,current year date of apppfcaTionn legal or equitable owner?
iri!!4 an ❑ 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 different than that of appbcard,indicate below- Is rty in question:Annually Assessed
gal Property ❑Anima/hi Assessed
Name of Motile Home(IC 6-1.1-7)
mortgagee or contract seller
Al elaa-C1
Address of mortgagee or contract seller(n and t,city, ,...
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 Taring District? Has this deduction been requested on property
county in Indiana? for current year?
1:1 yes El No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amouN of.
20 20 .1. • ^n , I 20 20 20
u
Signature of County Auditor /3 /� O32. C� - — - -Signature
Date(month,day,year)
I/We certify under the penalty of perjury t D I-U we r 1NrO....°2C/3
1d that the applicant is a resident of Indiana and
owner I contract buyer of the aforementior
Sigruture/ownesaname) I\,O. .....lA/Q Date(month,day.year)
Fqd nt address of applicant(number and street,city,stare.e._—. ._
lo,--1 1 E Foster CA-, c+ Rretr,h ;LIv r i
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 LP code) _