HomeMy WebLinkAboutMortgage_Davis (20) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year I
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° FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(Rtt/6-09) yT• g
Prescribed by Department of Local Government Furore F Y F.I
INSTRUCTIONS: 1N Form mom :
To be filed in person or by mat?with the County Auditor or County Recorder of the county where the property is located.
Ring Dates: 1) Real Property:Must file during the year for which the deduction is sought J U 1 go 6unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly 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.
fr conW buyer-see restrictions on reverse side) GIBSON COUNTY AUDITOR
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"Keyr number/l d escription Record number Page number t1 I de - r.t-/9 - goo - DO`S /023 - o .), 7 Lora as -37
Assessed valve of real property of Mort gage/,Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appfi ant the sole
March 1,current year March 1,current year date of application l legal or equitable owner?
/ / Of 000 ❑ Yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than mow,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually 1.1-7)
•Name of mortgagee or contrail seller
Cyvt, T F e Lt
Address of mortgagee or contract seller(number and street city:state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address pf assignee(number armed street coy.state,and LP yode)_ a - b o ^ ,AO
Does applicant to property in any other SF F I If yes,9what county? . WhattTTaxing District? Ha rta��been requested on property .
❑ yes ❑ No ❑ yes ❑ No
COUNTY AUDITOR
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Deduction approved in the amcont of. .- -
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20 20 20 20 7 D/-a Wet j•f\r- a
Signs nty✓1 Auditor
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4.`. ,, .�--� County .
Ca d,(t1\'�iO• •rte/C3• -
I I We certify under the penalty of perjury that the above and foregoing information is true ant...- T M'1„,J•••••7
Ver/contract buyer of the aforementioned property on date application is filed. /9W to
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■ , -..i na Date p,.....
( resident add— e�.r street city,state, ZIP code)
arson authored b executed Power If Attorney or by IC 6-1.1-12 .7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) • •