HomeMy WebLinkAboutMortgage_Gibson (2) a„p. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
:;„s= FOR DEDUCTION FROM ASSESSED VALUATION
c.. ;;'=sr State Form 43709(R11/Department of L �""'f
\C-:::,,- •;" Prescribed by Deparmem of Local Government Finance .9@YJ�
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INSTRUCTIONS:
I Fond bled with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. AY 7 q p
.a Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. 7 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 - ❑ County Recorder
See reverse side for additional instructions and qualifications.
Ap t( rorconbect buyer-see ' . on reverse site) ( �Z '�1 \ GtRSuN (:Oct TY AUDITOR
Taring District Key number I legal description J\ Record number Page number
9‘0 " 11 - 33 - loo - oo '{ - 3y07-- ma- / /3 / 77 7
Assessed of real as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applcant the sole
Marra 1, year March 1,anent year date of application legal or equitable owner?
r-—1// Y 8 1 ❑ Yes ❑ No
If no,what a someone his her exact share of interest? tt owned with someo &MerMan spouse,indicate with whom
If name on record is different than that of applicant.indicate below: ____ I Is the property in question:Annually Assessed
11 Peal Pnnoertv_fl ANWally Assessed -1
Name of mortgagee or contract seller �-OL Mom P 50 u- L_t3F1- D
Address of mortgagee or contract seller(number and street,city,sore.and ZIP code) �0/ Cr511- A/ 1
Name of assignee or other owner or toter of mortgage 43 -/777
Address otassimnee(number and street,my:state,and ZIP code)
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33 - ( 1 a- A- C.
Does applicant own property in any other I If yes,what county? - What Taxing District? Has this deduction been requested on property .
county in Indiana? me
0 Yes ❑ No for an yearn ❑ Yes ❑ No -
COUNTY AUDITOR
Deduction approved in the annum at
20 20 20 20 20 _ - 20 20
Signature of r 'dry Auditor , • County Date(month,day,year)
? nder the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
ct b r of the aforementioned property on date application is filed.street es L;n )[�'/q/t� /��1�dL,//�cr/7ry]�- / 4474(.6--- Date(month,day,year)
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of autti0nzed person (number and street,dry,stale,and LP code) .