HomeMy WebLinkAboutMortgage_Michel (8) �_� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-.27.-: ,24 = FOR DEDUCTION FROM ASSESSED VALUATION
' ' State Form 43709 De artm/6-09) /5 1 U\ FILED
I 1 1
Presented q'Department of Lod Government Emma
File Mark
ebTRUd in rr-B 11 Lo it with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is locate i
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 dining the twelve(12)monn
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications. GIBSON COU I Y AUDITOR
Applicant(owner or contract b -see restrictions on reverse side) .
Lilt( - Key description Record number Page number
16o - / 9 - /6, - 3oo - ooh . 35 -o .tS ao ( ?- G3j3
Assessed value of real property as of Mortgage/Contact Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Month 1,current year Man3r 1,cement year data of legal or equitable ownowner?me
6480 El Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
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If name on record Is different than that of applicant indicate below. is to a
}.�5 P Party in question:Annually Assessed
.I .Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of rtnrtg or contract seller ' -
Address of mortgagee or contract seller(number and street.city,state, ZIP code
Name of assignee or other owner or holder of mortgage
Address assignee(number and street,city,state,and ZIP code) y�ra`5'e1' T
, T s cJ « - 3 -10 A c 1J )�o. aDl a
Does applicant own property in any other If yes,what county? what Tad( ••••••......
county in Indiana? ❑ Yes
❑ No Card )\r0. 6873 ... ..., lo
0 COUNTY AUDRO' Or o pO _
Deduction approved In the amount of. 0 0
20 20 20 20 20 20 20
Signatory of County Audio( / ` County Data(month,day,year)
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.
1' Ilrewne/s )
kg / / / Date(month,day,yew)
Full resident address of applicant(number and street,eb/state,and ZIP code)
134 5 - rOon E. ir-1--- .eale.*1 t L- iut- g
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 sheet ay,state,and ZIP code) .
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