HomeMy WebLinkAboutMortgage_Coomer (7) €� r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
7;44:-t- State Form 43709(R11/6-09) IL y
V`Un Prescribed by Department of Loral Government Finance
ED
INSTRUC77ONS:
trv�y{y F 67ed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is'-M*1\ 1 • 1
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. "�f'h 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. f A my Recorder
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See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Ap owner or contract buyer-see restrictions on reverse "e)
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T i Key nu /legal tln-Option Record number Page number
p aJ 1 Iq -aD0 _oop, (our —oaf 2o13 -706
Assessed value of real cperty of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,amen year Ma 1,anent year date of appGCalion legal or equitable
ell owner?
l I O DU ❑ 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 apprs:ant,indicate below. Is the property in question:Annually Assessed
Q Real Property ❑Annually Assessed
Mol>tle Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(n astreet,city,state,and LP code)
Name of assignee or other owner or holder of mortgage
Add of assignee(number and street,city,state,and ZIP code) ,r
rT PEE 1R _ d - /0 l ry
Does applicant own property in any other If yes,what county? What Taring Dstrid
county in Indiana? ❑ Yes ❑ No 2
COUNTYAUDROR Drawer NO J
Deduction approved in the amount of 7
zo 20 20 20 zo- Card NO.
signature', of Cprmiy AudttttorA �- / ` - County Date(month,day,year)
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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/contract buyer of the aforementioned property on date application is filed.
r - hill name) Date(month,day,lean)
,
/Full - 'ant address of apprcant(number and street,city,state,and ZIP code)
C` /3d g 20o S Pr live eici- //V `/ 7(070
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 sheet,city,state,and ZIP code) • 1