HomeMy WebLinkAboutMortgage_Breivogel a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year I
K t ,; FOR DEDUCTION FROM ASSESSED VALUATION
Lr, State Form 43709(R11/6-09)
Prescribed by Department of local Government Finance .
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INSTRUCTIONS: ,
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To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. . F• I •I.+ct �-.
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 Q�n�
before March 31 of each year the deduction is sought 9
See reverse side for additional instructions and qualifications. _
Applicant(ownprpr -see on reverse side)
1111411 GIBSON COUNTY' AATOR
Taxing District number/ I desorption Record number Page
6-Ig)c-ioo-000k • l3 -oa5 3 I?3e
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaiC as of Is the applicant the sole
Mard1 1,current year Marti 1, t date of application legal or equitable owneR
❑ 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 the property in question:Annually Assessed
Q 'i 13 ❑Real Propem ❑Annually Assessed
l Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
r el
Name of assignee wother owner or holder of mange
Dtaiver NO a0IS
Address of assignee(number and street,city,state,s
Card NO. 3�p 7
Does applicant own property in any other Has this deduction been requested on property
aunty in Indiana? ❑ Yes ❑ No 4 13y 3- for anent yeaR ❑ yes I �� ❑ No I_
COUNTY AUDITOR -
Deduraon approved in the amount of:
20_ 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,)ear)
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/co A: -ct buyer of the aforementione4property on date application is filed.
• <� •. to i full name / Date d y,year)
;- A, q1 , / ��$13
F
/,-1 sent of applicant(number and street. ' ,state,and ZIP code) ..
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,srafi,and ZIP code) _