HomeMy WebLinkAboutMortgage_Miskell (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C T i. i Year I
. ,� FOR DEDUCTION FROM ASSESSED VALUATION I :Est
' State Form 43709(R11/6-09)
Presaibed by Department of Local Government Finance
File Mark
INSTRUCTIONS: M I t
•To be filed h person or mad with the County Auditor or County Recorder of the county where the • filed
Pe by h ty ry property is located.
Filing Dates: 1) Real Property:Must fi l e d u r i n g the year f o r w h i c h t h e d e d u c t i o n i s sought ..I. • itor
2)Mobile/Manufactured Homes not assessed as Real Property Must rile during the twelve(12)months I�I •.4.- i R
before March 31 of each year the deduction is sought k ty Recorder
GIBSON t • . • : • •
See reverse side for additional instructions and qualifications. .
Apprcant(owggr or coguact brryer-see re m reverse side) ( ^„a
K(jj//(nJ( /{— 7y/I
Tatd9Disthist Key number/legal d Lion Record number Page number
f
q 10-13-2 9-ido oyoy, Sa- cox/ 070° 94's
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contact indebtedness impala as of Is the sppfrant the sole
March 1,one year Martyr 1,anent year date of application legal or equitable owner?
t30 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,intricate with whom
It name on read is different than that of appacent,indicate below. rrI�ss the property in question:Annually Assessed
9(1 Real Property ❑Annually Assessed
- _ / ___
Mobile Home(IC 6-1.1-�
Name of mortgagee or contract seller
Address of mortgagee or contract seller(n and street city,state,and ZIP code)
' 02008
Name of assignee or other owner or holder of mortgage - - -- — 1
Drawer NO
Address of assignee(number and sbee4 city,state,and ZIP code)
94/3
Card NO.
Does applicant own property in any other If yes,what county? - What Ta: the .
county in Indiana?
❑ Yes ❑ No J No
COUNTY AUDITOR .
Deduction approved in the amount of:
20 20 20 20 20 20 20
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/contract buyer of the aforementioned{,f'orrementioned property on date application is filed.
�vV / / VL4:4e, Date(month,day,year)
Full resident address of applicant(number and street aIX state,and ZIP code) .
X 6 7 791 c2 So 9 fi2 All CiE scr0 cell D 4176 97
Person authorized by duly executed Power of Attorney or by IC 6.1.1-12-0.7 Date(month,day,year)
Address of authortzed person (number and sweet city,state,and ZIP code) .