HomeMy WebLinkAboutMortgage_Whitehead (6) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
- State Form 43709(R11/e-09) F I E ,)
Presented by Department of local Government Finance
File Mark
INSTRUCTIONS: r pry
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located.MAk 141101 '
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 /� b
before March 31 of each year the deduction is sought ,//L oDR Recorder
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side)
%J4 CJ
Tara istroct Key number I legal description Record number Page number
et-al-2(a2 . ;(a -/a _03 - YOU -0001 . 137- OA7 ;,o /3 / ogb
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,current year Mardi 1 current year date of application --t legal or equitable amen?
& f con ❑ Yes ❑ No
If no,what is his/her exact share of interest? it owned with someone other than/spouse,indicate with whom
If name on record is different than that of applicant,indicate below:
Rd property in question:Annually Assessed
Real Property ❑Annually Assessed
Motile Home(IC 61.1-7)
Name of mortgagee or contract surer —r It
Irt Address of mortgagee or contact seller(number and street,city.state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
P-r 5‘._, se- 3 - A- - / 0 a .i 5 A- C.,
Does applicant own property in any other If yes,what county? What Taxing District? Has this Deduction been requested on
county in Indiana? for current yea property
❑ Yes ❑ No ❑ Yes ❑ No
COUNTY AUDIT
Deduction approved in the amount at NO
20 20 20 20 G
Card NO. .... 4
.....Q. �
..........
Signature Comity Auditor Coin /�
-7) ZO. Vim/
I/We certify under the penalty of perjury that the above and foregoing information is u ue ep __-_ diana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature overt NU me) `1 Date(month,day,year)
Full resident address of a t(number and(1 s\streee^t-ci state,aardrV ,ZI-P code)
X 2a-1(D act N „-- -N Y? ( 70
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) sA�
Address of authorized person (number and street,alit:state,and ZIP code) ,`7e\
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