HomeMy WebLinkAboutMortgage_Walters r f}, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
-..' State Form 43709(R11/6-09) y
Presoibed by Department of Local Government Finance p
INSTRUCTIONS: 1 LED
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. F
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. ��,,((��R County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)montH? ! 2`2p#,�
before March 31 of each year the deduction is sought. L� County Recorder
See reverse side for additional instructions and qualifications.
Applrant(owner or contract buyer-see restrictions on reverse side) GIBSON COUN�DI•r
pd. P I�alltr� crud Ani}� ITC- U-t rS OR
ick Key number/legal description Record number Page number
c� u. 4 -1 a -049 - 1od - oo1-1 . / S-a z8 oZo/..j 1223
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Mandl 1,current year March 1.current year data of appli anon II'' legal or equitable owner?
S151, Z�q-. L� g /51. 2.74.Cx.) El Yes ❑ No
If no,what is his!her end 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: Is the property in question:Annually Assessed
gl Real Property ❑AnnualyAssessed
Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract setter /?
rim. -hi(8 Mar k0ckot COON')c,r\y
Address of mortgagee or contract seller( and street,b ty,stat ,and ZIP code)
52c>1 Kirl,Skj 11-:0c._ , PATJ ii eC(3G , Cdr,c,,,nr..t; ( 4 452-2-7
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,dry,state,and ZIP code)
Does applicant own property in any other If yes,what county? what Taxing District? Has this deduction been requested on property
county in Indiana? ❑ yes ® No for current year?
❑ Yes ❑ No
COUNTY AUDITOR •
Deduction approved in the amwnt of:
_-_______
20 20 20 20 .-� 2J
Signature CourtyAWltor County i .. 0I.••
.••..
IF We certify under the penalty of perju 2 ve and foregoing information is true and ••
owner/contract buyer of the aforementioned property on date application is filed. Card NO. ..........,,••••••••"
Full/!�"'..� of. : r' �a •street city,state,and ZIP code) ,
Jerson authorized by duty executed•• of Attorney or by IC 6-1.1-12-0.7 Data(month,day,year)
Address of authorized person (number and street,dry,state,and ZIP code)