HomeMy WebLinkAboutMortgage_Hume STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �Coun Township Year I
FOR DEDUCTION FROM ASSESSED VALUATION
tI. State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: „^Y 2tl'f Ned _
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property istcal t .Fibrin
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12) nths
before March 31 of each year the deduction is sought - County Recorder
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Ap (owner or-contact buyer' on reverse side)
T ' is Key number/legal d Record number Page number
AAAn..f e-y— I (26 — /a -olo - tto/ - 0°3. ,3 / Y,Dote �Df3I / s & 7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Its the appfrrint the sole
March 1,current year March 1,omen year date of appaca legal or equitable owner?
�i 0 0 O ❑ Yea ❑ No
If no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of appfcanL indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
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)
Name of assignee or other owner or holder of mortgage _
Add of assignee(number sire 4 coy.state,and LP code) t
-]
. i Z g yep Drawer NO DRQ)
Does applicant own property in any other If yes,what county? - What Taxing Di l 1�
county in Indiana? ❑ No / 5`v" J
❑ Yes Card �1�.
COUNTY AUDITOR 90, ouJ _
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of Caw When / I. v 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 I contract buyer of the aforementioned property on date application is filed.
KSignature is MI name) Date(month,day,year) ,
f � �
F " e address of appGcapi(num rand street,aTy,state,and ZIP code)
/709 Col`., ._„,,/ D, :rie. . PC/II.. ail., . Loch d1G10
Person authorized by duty executed Power of Attorney or byte 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and saee4 otty state,and ZIP code) _