HomeMy WebLinkAboutMortgage_Nurrenbern s. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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�,,; FOR DEDUCTION FROM ASSESSED VALUATION
K`I_:• State Form 43709(R11/6-09) i (,.•
Presented by Department of Local Government Finance
File Mark
INSTRUCTIONS: qqnnAA��..�t,,
To be filed in person or by mail with the CountyAuditor or County Recorder of the county where the property is locatecM AR It 2643It
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. ❑ 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. / unty Recorder
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Appfi t(owneror contract buyer-see restrictions on reverse side)/
�/ DisS led�J Key num/(tbeerr/legal description/
Record number Page number
,� a6 - /9- 19 - /o/ -OOO . btu - o 1-G 1o /1- &L/y /
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,current year date of application legal or equitable owner?
3 ODD ❑ 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 appbranL indicate below: Is the property in question:Annually Assessed
❑Real Properly ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) -11�
Name of assignee or other owner or holder of mortgage r (o3 1�1)°CI
Address of assignee(number a t.cdy.state,and code) �Y,_J v�� ;O/
/ cc d -GC, ,Q r Drawer NO
Does applicant own property in any other If yes,what county? What Taring District
aunty in Indiana? ❑ Yes ❑ No
Card NO. (ow -
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature Canty 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
owner I contract buyer of the aforementioned property on date application is filed.
Jwners tu0 name) Date(month,day,year)
ent of applicant(number and sheet,all:state,and ZIP code)
0 (� S w . 6lnrI Fa- 4rc cL _-n y > 6y?
• Pe authorized by duly executed Power of Attorney or by IC G7.f 12-0.7 Date(month,day.year)
Address of authorized person (number and street,c/ty,state,and ZIP code) \\