HomeMy WebLinkAboutMortgage_Fulton STATEMENT OF MORTGAGE OR CONTRA S� County Township Year
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FOR DEDUCTION FROM ASSESSED VALU
CoeState Form 43709(R71/6-09) _ I
Prescribed by Department of local Government Finance
File Mark
INSTRUCTIONS: JUN 10 2013 Form filed with
b 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 1: 'ht. County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property M. fC : . 'i1' ►/e e(12)months
before March 31 of each year the deduction is sought. ❑ County Recorder
GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or buyer( on rel`\F�
Ta 'ng Key number/legal description Record number Page number
U'�LUi( Cp /a-78-34907-oat:) 39 bag 9i/a 537/
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Marts 1,=rent year March 1.anent year date of application legal or equitable center?(
corm ❑ yes El No
If no,what is his/her exact share of interest? If awned with someone other than spouse,indicate with whom
It name on record is different than that of applicant-indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Motile Home(IC 61.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contact seller(number and street city state,and ZIP
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 I If yes.what county? • What Taring District? Has this deduction been requested on property .
county in Indiana? r
❑ Yes ❑ No _ for current yea
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount at
20 20 20_ 20 20 20 20
Signature
}colt Auditor � // // County Date(month,day,year)
S ti�u���C L T 7�
I 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.
(owners lull na ^,t ///��� Date(month,day,year)
Fon rat yappftont(pumber a�/•Xssheett, '^1 to 2/Pcode) d /
auuthorized by duty/exexeecuteedJ Power of Attorney or by IC 6-1 `/y/ rtilA.C,/llKlyr�' Date(npnt,day,year)
Address of authorized person (number and steel rdy.state,and ZIP code) .