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HomeMy WebLinkAboutMortgage_Debord (3) STATEMENT OF MORT( t6 CONTRACTINDEBTEDNESS aunty Township Year•C!j) FOR DEDUCTION FROIJ�AS SED�ACCIATIZNERED FOR TAXA'ION State Form 43709(R71/609) to final acceptance for transfer Prescribed by Department of Local Government Finance • day of MAR 112 2013 File Mark INSTRUCTIONS: To be filed in person or mad with the Court Auditor or •un Re.. �r Al' •- ..1 n. - the ro Form filed P by N N f7, v/- P peljpated. Filing Dates: 1) Real Property Must file during the year` w r..r' �i pr Gibson county County Auditor 2) Mobile/Manufactured Homes not rise-•', •- Inn' ''D"' :M file during the twelve( (72)monms ❑ ty before March 31 of each yearQ$O{6cgm 1T• - ❑ County Recorder See reverse side for additional instructions and qualifications. 'A'p/p6tant(owner or contact buyer y-�see restrictions on reverse side)) � nIL II 14-nr, +4Y E. -be-Eo i anA Nano_ Ft• (A21'.llrel Taring Key number/legal description Record number Page number Y1 ��,_, -ts(r Q0,-mar 95 -Gc?R' , c t 3 / a. 8 Assessed value street property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole March 1,emit March 1.current year date of application legal or equitable owner? -5 I 2.0 i 1 Ce•0 0 —1 I2-0 , IUO. 00 El.Yes ❑ No If no,what Is his I her exact share of interest? 'If owned with someone other than spouse,indicate with whom If name on record is different than that of applicant indicate belaw'. Is the property in question:Annually Assessed ❑Real Property ❑Annually Assessed Mobile Nome(IC 6-1.1-7) Name of mortgagee or contract seller (� �c-F.ftrc\ MOYTC(a0. ( s'>ry-r?Dr. Address of mortgagee or contract seller(number and street,city,mate,and ZIP doder SccI f(;nncIFL b.-11P--- ) l/� i rx ri.ri no.1.2. x;11 45 22-2 Name of assignee or other owner or holder of mortgage Address of assignee(number and street,cry,state,and ZIP code) Does applicant own properly in any other If yes,what county? What Taring District? Has this deduction been requested on property county in Indiana? — -______ f w co year? ❑ Yes © No ❑ Yes ❑ No COUNTY AUDITOR �,°�°7(�///��� Deduction approved"in the amount of: Drawer 1N aW/ 20_ 20 20 20 Card NO. ...•I. �Q8 1 Signature of County Auditor County ,fkn.,n E . - — Signature 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 Inolafla...0 owner/co buyer of the . -mentioned property date application is filed. Signature( .me) Date(month,day,Year) Full resi nt:.• - of a n her and t,oily,state,and ZIP code) P authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) \. Address of eu homed person (number and sheet,city.state,and ZIP code)