HomeMy WebLinkAboutMortgage_Lamb (3) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
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Prescribed by Department of Local Government Finance
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INSTRUC77ONS: e�p,,,pp g}
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located.APR 'Q'GN 1 3:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. Et County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months f�
oartbefore March 31 of each year the deduction is sought. ./I[ Recorder
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Appeca rater or contract b r-were son reverse sid
Ta Di ' Q'/KKey /legal pa�� 6.7.y3.4.71(/J.J.`/ Record number Page number
29- ��&6/A �3V•
of real property as of �� e/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app�nt the sole
March 1,anent year M�,current year date of appecat n22 d
legal or equitable owner?
/ ./ ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than sprear,indicate with whom
If name on record is different than that of applicant,indicate below. Is 1t property in question:Annually Assessed
SC) Real Profeny ❑/+^nay d
Mobile Nome(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number a 4 city.state,a IP code)
Name of assignee or other owner or holder of nnrtgage�] / 2 et, �/�i 5_76. / //ter
Address of assignee(number and street,city,state.and ZIP/P/,code• ) (� _ !Y
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 corm
❑ Yes ❑ No
COUNTY AUDITOR .
Deduction approved in the amount of:
20 20 20 20 20 f — —I 20 I. 20
Signature of County Auditor County - -_ .--- ;:<:-•��•r",�-t^'_-±`_'F_:.tom.=_.^'.�
•
I/We certify under the penalty of perjury that the above and foregoing information is true and cone �O/ /
owner./contract buyer of the aforementioned property on date application is filed. Drawer NO «f� d"
-SIg (nwne hin fi �3
Fail /"riadd /�of a / umbersd 4obsrate,and ZIPcode) I Card NO. L/l
r 878f 93-C S. t &On ('(/1 c y7(P 4( . i73,�D.CF�
-arson authorized by duty executed Power of Attorney or by IC 61.1-12-0.7
Address of authorized person (number and street cry,state,and ZIP code) ' .
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