HomeMy WebLinkAboutMortgage_Mair (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
:' FOR DEDUCTION FROM ASSESSED VALUATION F T D
•,--"'t`t State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: ^Y
To be filed in person or mail with the Court Auditor or County Recorder of the county where the properly M r r', T
pe by d ty ty P Per1Y is local
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 , rla.d
before March 31 of each year the deduction is sought I , €1.w,7�r •unty Recorder
See reverse side for additional instructions and qualifications. /� //) GIBSON C s • • " • • • • =
Appfi�n�ywnPr(or conbaa uyer-see ''reverse:e t '/J ! L
r l/Dist of r/`IKeyy •• ;legal esc ipoml/t //Te'////(�( !/�/{y/` Record mamba Page number
)(ira e , -i 2 is-030x- t 2-aa1z dr �3 �v 9r-
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/CCoann�tcdr�anctG ukebtedness unpaid as of Is the pL t the sole
March 1,anent year March 1,parent year date of apatit d legal or equitable o-xvneN
// ( ❑ Yes ❑ 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 roperty in question:Annually Assessed
eal Property ❑Mo 6-1.1-7)
Name of mortgagee or contract setter D/c
Address of mortgagee or contact seller(number and save4 city state,and ZIP code) /�
Name of assignee or other owner or holder of mortgage /1 n� r / Y/ J7,
Address of assignee(number and street,city,state,and ZIP code) �C)j�C� {y'l(-�(-/
_._ a-cine-^ ,� s_:..::.__ t county? . I What Taxing District? Has this deduction been requested on property _
for anent year? ❑ Yes ❑ No
t
i-Dral\rer NO C)1. COUNTY AUDITOR I-
I. 1t r •1
Card N ')%. 1095'
J��-v (�il/.'��{/�) ,.,fit 20 20 20 20 _
' v • County Date(month,day,jeer)
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 I contract buyer of the aforementioned property on date application is filed.
(owners tuff name) Date(month,day,yam
X �al 2�Ika44A•/(/�`
F I rests address of appfcant(number ar.*b....t city scaly ZIP code)
X jb 4624 (c/ x bI(/11 a�S1 eeS pu.16(u/%l4 97/ s�
Person aunuuc d by duty eAcu:ed Power of Attorney or by lc 6-1.1-12-0. - Data(m nit),day,year)
Address of authorized person (number and street,city,state,and ZIP code) •