HomeMy WebLinkAboutMortgage_Reneer (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
P. T" FOR DEDUCTION FROM ASSESSED VALUATION
± �'' State Form 43709(R11/6-09)
�` Prescribed by Department of Lod Government Finance FIf I Ep
File Ma
INSTRUCTIONS: ,�,rp
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.MAY 04 lisAwn t I J
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
before March 31 of each year the deduction is sought. J!L, n Y Recorder
See reverse side for additional instructions and q litications. GIBSON COUNTY AUDITOR
App6ca t(owner or contract buyer- sMction verse side)
'Key number number/legal description Record number Page number
ae l / o7 '1°3 - ooa • 3a O 8 2-.0 to 3590
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apWcant the sole
Mardi 1,current year 1,alrtent year sate of application legal or equitable owneR
jr If no,what is his/her exact share of interest? If owned with someone t rihans O e El Yes ❑ No
Pause.indicate with whom
If name on record is different than that of applicant indicate below. Is the property in question:Annuafy Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /t _ ,
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 ZZ�LP,code) ��_ __ _
Does applicant own property If yes,what county? What Taxing Distric
county in Indiana?
❑ Yes 0 N o _
COUNTY AUDITOR O v/�/�•••..
Deduction approved in the amount of. q
Card NO. .... .5
Lti20 20 20 20 �,/,{�./�/ .....co
Signature of ty Auditor . I County Date(month,day.yew,
I/ e 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.
y Signature(o es futl na7) F Date(month,day,Year)
.. /FWI t of aapp1 it(number and sheet, state,and ZIP code)
C all s 4- OIieriraoe . , thilAnS, (r N V76-7o
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)