HomeMy WebLinkAboutMortgage_Mason t_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County Township Year
.+ FOR DEDUCTION FROM ASSESSED VALUATION I
.J State Form 43709(R11/6-09)
�E�`_H'7 Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: III ff��II 71 (1 �(t1
To be filed in person or by mail with the County Auditor or County Recorder of the county whe7Lii}k ArdQelg+rMted. Form coed win:
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. County AudaOr
2) Mobile/Manufactured Homes not assessed as Real PfmgJr tbs /
roperty:Must file dui'' a tore !_ Recorder
before March 31 of each year the deduction is sought � J ill, n1Y
See reverse sAfe for additional Thstivc$kins and qualffications. GIBSON COUNTY AUDITOR
Applicant(owner or.. buyer-see re rse side)
�_/!L./ ..1tP'/,&A A r 11I It
T Key number 1 legal desr>iption Record Page number
� (o-Iri' /`T'�203-�0 o265-dab I a7o3'
Assessed vdue of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Ls the applicant the sole
Marts 1,current year March 1,currenMiear date of application legal or equitable
oN
share e
..// ❑
❑
If no,what is his/her exact ste of interest? If owned with someone other than spouse,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 contract seller \/ ,/ //)
Address of mortgagee or contact seller(number and t city.state.and code)//.#`/
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city.state,and ZIP code)
Does applicant own property in any other If yes,what county? - What Taxing District? Has this deduction been requested on property .
county in Indiana? ❑ Yes ❑ No for current year?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the annum oft
20 20 20_ 20 20 20 20
Signature of•• - Auditor r • County Data(month,day,year)
se 'J \dAaz _ Al_ . I Alt_
I I We certify under the penalty of perjury that the above and foregoing information is • e and correct and that the applicant is a resident of Indiana and
. er I contract buyer of the aforementioned property on date application is filed.
y:. .(owners M/name) Date(month,day,year)
%;a, ill
FuI 19:4ia !+* tli, ;ii,s. .,t .umber and 4 state,and j ZIP otle
/ • f. (c i tic�aI o�✓1 1.17,cSi
P authorized by duty executed-. . of Attorney or by IC 6-1.1-12-0.7/ Date(month,day year)
Address of authorized person (number and sheet c%state,and ZIP code) .
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