HomeMy WebLinkAboutMortgage_Meade (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t±oFOR DEDUCTION FROM ASSESSED VALUATION
e" State Form 43709(RU/F09)
Prescribed try Department of Local Goverment Finance
ile
INSTRUCTIONS: I,'�
To be filed in person or mail with the Court Auditor or County Recorder of the county whem the property P by County ry ry p perry is located.
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 A
before March 31 of each year the deduction is sought. 2R 2143nty Recorder
See reverse side for additional instructions and qualifications. /1,
Applicant(. -r or contract buyer- --restrictions reverse side) JJ�/!7L(
! �_ f �^_ _ J GIBBON COUNN I'
Trigg D Key number/legal d / f"`{-o-- J Record number ^tag®atber
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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
March 1,anent year March 1.current year date of applications /t legal or equitable ovmer?
JV•� DO 0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than sprourve,indicate with whom
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Motile Hone QC 6-1.1-7)
Name of mortgagee or contract seller m r _
Address of mortgagee or contract seller(number t city,state,and LP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,dry,slate,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District; / — /59e0 county in Indiana?
❑ Yes ❑ No
COUNTY AUDITOR Zo�/ (�
Deduction approved in the amount of: v d
20 20 20 20 20 20 I ..,
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 property on date application is filed.
IX Signature(owners/W name) Date(month,day.seer)
O -fr%--i 40tri iv rt-ees-
Full resident address of applicant(number and sheet city state,and ZIP code)
SS4i N, jt1PPer PGA-Di PA-mK>AI rJ y7bld
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,dry,state,and ZIP code)