HomeMy WebLinkAboutMortgage_Smith (33) ;Tr. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
Fl
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. A Form fled tw1i��::
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. A P r 1.]Z011unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must tile during the twelve(12)months
- before March 31 of each year the deduction is sought. - ❑ County Recorder
qualifications. / a
See reverse side for additional instructions and rralificatbns. "UMW.
Applicant(owner oroplrpcytuyer-xee irm verge a GIBSON COUNTY AUDITOR
Taxi'(strict Key number/legal description Record n b Page number
ii a(0 -QOO')-/03 -000. S&P-Dag' I er D1�
Assessed value of real property as of Mortgage/Conbar t indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appliant the sole
March 1,current year 1 rtent r date of application
legal a equitade
❑ 0 No
o
If ro,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 ❑AnnuaayAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller _^
Address of mortgagee or contract seder(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,s - -- —-
nun ov'.r property in any other 1 n/1 1, D. for this deduction been requested on property
❑ Yes ❑ Drawer NO /\V1n000 ea ❑ Yes ❑ No
•
Deduction approved in the amount of: Card NO. (�V7yy 1
1
20 20 Cos ( 37(1,S 5 20 20
I i I
Signature of County Auditor County Date(month,day,year)
I I We certify under the•-natty o e - above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract im o to application is filed.
/ Date(wash,day,year)
of a:. .. t(number: .street,city state,and ZIP rode)
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,city,state,and ZIP code)