HomeMy WebLinkAboutMortgage_Lee (3) 4Q ..
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'_"�;; FOR DEDUCTION FROM ASSESSED VALUATION
�'= t�JI� State Form 43709(R71/6-09)
toe
.�s'7 Prescribed by Department of Local Government Finance
J1J11;(a
INSTRUCTIONS: ,y�t�d
pm
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. FoI-1 F R f!G 2013
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
before March 31 of each year the deduction is sought - II' •_• n '
See reverse side for additional instructions and qualifications. GIBSON COUNTY ry A
Applicant( r contract buyer-see onreerseside) � UNTYAUnITOR
C �.L/h/V�R— in 1 0 4
Taxing D' et Kenai /legal da 6 a0d -coo - S2I g r C-b& Record1 yuyer P5 b '7D
Assessed vago of real property as of oollMorgga',j Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as ofof/� Is the applicant the sole
March 1,arrant year March 1,ceI rr�(i date of application legal or equitable owner?
IQ 0 ea VV� ❑ 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 applicant.indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller e,y/ a , `
Address of mortgagee or contract seller(number and street city1s tattee,aaMVLP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and 7'° -..t II-_L fr - - -
Does applicant own property in any other I L L.L f JDI4 Y C Has this deduaim been requested on properly
county in Indiana? ❑ Yes ❑ No t�/)1 for current year? ❑ Yes ❑ No
SINN
Deduction approved inure amount of: Id - 500
20 20 2u I N zu 20 20
Signature of County Auditor - County Date(month,day,year)
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 Indiana and
owner I contract buyer of the aforementioned pro•- on date application is filed.iii nor
:. :es full name)n'aamme))��'��`f �'/r`/yi/_1 / Date(month,day,year)
all _ 11dress of a (number and street, e,state,a••ZIP code)
a �3 s sQsl o I
Person authorized by duly executed Power of Attorney or by IC 6-1.1 1.7 Date(month,day,year)
Address of authorized person (number and street,cny,slate,and ZIP code) .