HomeMy WebLinkAboutMortgage_Scott STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year _
!` l N
FOR DEDUCTION FROM ASSESSED VALUATION
f!' State Form 43709(R71/6-09)
Prescribed by Department of Local Government Fmnarne 1 /
File Mark
INSTRUCTIONS: A P
r •�x• .
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is local
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought 0 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)non
before March 31 of each year the deduction is sought. - , I.i, r.rf, rig • my Recorder
See reverse side for additional instructions and qualifications. GIBSON CO ` • i • • -
Appfcent owner or contract b r-see(reeCs/hirbwa on re side) (/�i/1✓
4.0 0 Taxing D Key num /legal desaiption / .! p - obi.I. oZ SS O oZ
Record number Page number /7
�,: . �- -^�- a[� - is - /?- 3 4 l a— 577 7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,cement year date of application
.. 5 o o � / legal or equitable owner?
1 3
- /�O ere El yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spdtse,indicate with whom
If name on record is different than that of applicant indicate below Is the
property in question:Annually Assessed
teal Property ❑Arintraly.4ssessed
Montle Home(IC 6-1.1-7)
Name of mortgagee or con.... : -r
e n •,Q •
Address of mortgagee or contract--Oer(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assi ee(number and street city,slate,and ZIP code) gilts
Does applicant own property in any other 7.11-- --1--If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes I for current year?
❑ No (`/+��j'' /� CI_v?...-_-r=+----
COUNTY AUDITOR 3WI11 0A�nn- -3-
f
Deduction approved in the annum of: Q
20 20 20 20 /a.- 5'» 1 ''
—
County
I
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.
, (own? rtrey+ / /a / Q Date(north,day.Year)
Full resident address yigna
/2 E 7o9-51r1(mrm !and stneeWy,/ rand /N code)
't 7 6 T/-v
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street 01%state,and ZIP code)