HomeMy WebLinkAboutMortgage_Harris (6) Si STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
t♦' �`� FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance :� ;_•
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INSTRUCTIONS: Form filed with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. AAAY 1 i t�:ounry Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)month
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications. I, im e-t
Applicant gor contract buyer-see on reverse site) GIBSON COUNTY AUDITOR
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Thom" District fey number/legal de trip Retort?number Page number
'`i�( >�L a a(„- rt • a - 4D -Oco, I - nr q der l3 X64.?
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app&ant the sole
Mardi 1,current year March 1,current year date of app0<ation legal or equitable owner?
IGOo Yes 0 N
If no,what is his/her exact share of interest? J If owned wdh someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below Is property in quest=Annually Assessed
property. oPerfY ❑MoMbile H 6-1.1-7)
Name of •. ee or•.. _. seller r
dress of mortgagee or•..•.--seer(number and street,city,state,and ZIP code) n
7L1 arrµ
Name of assignee or other owner or holder of mortgage ,'r7(
Address of assignee(number and sheet,city,state,and VP code) 13_d SAS
Does applicant own property in any other If yes,what county? K I Property .
county in Indiana? ❑ Yes trio _I Yes ❑ No
C11� COUNTY AUDITOR -
Deduction approved In the amount at
20 20 20 20 20 20 20
Signature of County Auditor • County ' Date(month,day,year)
I 1 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.
Its full tome) �f /, Date(month,day,year)
resident address of a O t(number and street,oily,state✓a/r�+e�Z!�E]code) f� u �5 � 4'7 3
/O 0 0 u K 61-)a. or ✓ C3v/2• • T f f�
authorized by duly executed Power of Attorney a by IC 61.1-12-0.7 Date(month,day,veal
Address of authorized person (number and street,city,state,and ZIP code) •
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