HomeMy WebLinkAboutMortgage_Collins (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
b??. FOR DEDUCTION FROM ASSESSED VALUATION
;i�'-J 7-.1 State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is 1EE'ejI F
Filing Dates: 1) Real Property:Must Me during the year for which the deduction is sought. ❑ County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months UN • f52 1 y,_„ Recorder
before March 31 of each year the deduction is sought - J IL.0 JFou
See reverse side for additional instructions and qualifications.
Applicant(g err or contract buyer-see restttkrns on re 'side)
GIBSON rot min'AU ITT
Ta` . Irma. Key number I legal description Record number
3 i�c 4 n.c.a#�x� ? -la - o? - yen - oo3- a-68 - orz8 ?-0 1-3 ,),o6/
Assessed value of real property as of Mortgage/Canna indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the avian the sole
March 1,anent year Mardi 1.current year date of application legal or equitable owner?
7 a Ono owner?❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other thanrspouse,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 Assessed
• � Mobile Home(IC 6-1.1-7)
Name of mortgagee or canna seller y ,�L T c c{ `
t
Address of mortgagee or contract seller(number and street city state.and ZIP code) — _
Name of assignee or other owner or holder of mortgage 7� _
Add of assignee(number and street city state,and ZIP code) D 1 :j}}'C j- N
T N SE 7 - 1 - /o . Yo 4L NO ( 0/3
Does applicant own property in any other If yes,what county? - What Taxing Dish
county in Indiana? ❑ Yes ❑ No C
a ard j\\r0. ...aO�JQ / --
COUNTY AUDITOR h I F '••+ .. —
Deduction approved in the amount of: 1 /°C OM IV
20 20 20 20 20 20 20 -
Signature of County Auditor • County v Date(month,day,year)
A
I I We certify e penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
"\ Slgnatute fs Ai name), Date month,day., )
L/side Ltl it rnt(..
`y Full resident address of appr�/nt(number��'d°street a1y,ate,and ZIP code)
r'1 �1, Tin-, )?cpt4- Princtdo,1)T'ncLc.rc 1/)420
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) •