HomeMy WebLinkAboutMortgage_Graper (2) .. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
f State Form 43709(R11/6-09)
to,
Prescribed by Department o<LOral Government Finance
F IL
INSTRUCTIONS: fd�
Form filed with:
:::
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. A pn� ' '
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. A? 1__I noun 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. I ❑ ,Co a�1 e•'•'•er
See reverse side for additional instructions and qualifications. gill n 'I'"?"
Apr/ • -r or buyer resrtcgonre , "2).% GIBBON ( Ol1NTY AUDITOR
Ta 'rg/istrict' by (.,[ I descri f/ / _ Recant number P ber
I - . o;=aoo - CO 1 r o.-93 CO,s 40/3
• - _•rah*of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract' ebtedness un d as of' Is the applicant a sole
March 1,current year Marra 1,current year date of apptigti legal o
/'6/l or equitable owner?
0 ❑ Yes ❑ No
If no,what R his/her exact share of interest? If owned with someon other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below Is property in question:Annualy Assessed
Real Property ❑Annually Assessed
Motile Horne(1C 6-1.1-7)
Name of mortgagee or contract seller
a_20—Address of mortgagee or contract seller(number ant, e.and ZIP
Name of assignee or other owner or holder of mortgage
`2() vm 07-3 - /o L. 9a9no
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? - What Taxing District? Has this deduction been requested on property .
county in Indiana? ❑ No far current yeah ❑ yes ❑ No
❑ Yes .
I COUNTY AUDITOR
Deduction approved in the amount of
• r
20 20 20 20 20 20 20
Signature of County Auditor i County 1 Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is trui G n r1 � "��O�s I d
owner/contract buyer of the aforementioned property on date application is filed. n Fi •
1 Slgoa/�/yE/V/�ch refs � APRIL
.[ Full resident address of applicant numbe;{nd street,01%state,and ZIP code) /� _ ^ I
l� 4'%' / F `1 SU 5 N✓t n L�C b'- to Y7(o7 e lfl J,)
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7
t
Address of authorized person (number and street,city,state,and ZIP code) -