HomeMy WebLinkAboutMortgage_Phillips (11) � ,: STATEMENT OF MORTGAGE OR CONTRACT J 1 'TEDNESS Township Year
-.� 1. FOR DEDUCTION FROM ASSESSED VALUAT T
j- State Form 43709(R111 rr09) I
Presented by Department of Local Government Finance
File Mark
INSTRUCTIONS: APR 1-2 2013
Form N
To be Med in person or by mail with the County Auditor or County Recorder of the county where the property is located. filed with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sou�W,t! [9�Counry Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must urin t tw nths ❑ County Recorder
before March 3l of each year the deduction is sought GIBSON
See reverse ski- for dditional instructions and qualifica'-•s. COUNTY AUDITOR
Applicant(owve tact buyer- restriction on re
. .r; �)s Key number,a: Ictj —10 D7-�a/-boo. FS -oa:r1oi.3 i29
Assessed vak*of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appfrant the sole
Marra 1,=era year March 1,current year 7 q I 83
data of aPPlieation legal Pole owner?or
/ ❑ 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 applicant.indicate below s e property in question:Annually Assessed
Real Property ❑AmluagYAssessed
Motile Home(IC 6-1.1-7)
Name of mortgagee or contract seller C /� L
LLie-11/}/71 Address of mortgagee or contract seller(number and street,city.state,and ZIP code)
an g-'
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own pro •-•— county? What Taxing District? Has this deduction been requested on property
county.in In•'' for current year?
^\_ n/I/1 ❑ Yes ❑ No
1/Y1\\\p5 ��()3Iro•l I COUNTY AUDITOR
(�,[/ \mA V 20 20 20 20
1 ` County Date(month,day,year)
0CHC2l3
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
\/y_�Jowner I contract buyer of the aforementioned property on date application is filed.
I cu0ca�a(t fun
/ire�d � Date(month,day,year)
Y�y (n mber and•••• My,state, ZIP code)
P . authorized by duly event _ r• ••y or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) . . ..