Mortgage_Sweppy „. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
1'- State Form 43709(R71/6-09)
Prescribed by Department of Local Government Finance
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INSTRUCTIONS:
To be filed in person or mail with the Court Auditor or County Recorder of the county where the property le W1 -
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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 ? au
before March 31 of each year the deduction is sought. A P 3 Z IQ7unry Recorder
See reverse side for additional instructions and qualifications.
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Appilc pt,(owner or contract b ;: -see restrictions on reverse sot ) r` T'"NM
IL//1�` \/ ,I • q Jit-644)_ GIBS N COUNTY
Taring District. Ke•numbs err-al - RRecord mum'oer' Alr ben
,e; - /3/3 •.4aa': ono. '3-oa6ll 1 ,3 ao3- S
4vcsed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole '
March 1,oltrent year March 1,current year date of application 8 Q0D legal or equitable owner?
❑ Yes 0 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 he perry in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Flare(IC 6-1.1-7)
Name of mortgagee or contract seller S/3
Address of mortgagee or contract seller(number and street,city,state.and ZIP code) -
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city.state,and ZIP Code)
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Does applicant own property in any other If yes,what county? What Taring District? `/ ,CPR/ e
county in Indiana? ❑ Yes ❑ No �Lt-/ / ,(��-(�/�
C OUNTY AUDITOR SH�`/� � 'S
Deduction approved in the amount of I 7()
20 20 20 20 20 /� ()Ou 8
Signature r County I w.'...--- -
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/contract buyer of the aforementioned property on date application is filed.
1 (owners jtA e) Date(month,day,year)
A Full resided of applicant(nu hi-ar?tlkLee4 city state,and ZIP code
an/ �”+sf To ?u VV74 Brim.-i�( , u76Y7
Person authorized by duty executed Power or 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) .