HomeMy WebLinkAboutMortgage_Andrews (2) aft. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co Township Year
�-j, FOR DEDUCTION FROM ASSESSED VALUATION II�M$�1II
' 1 State Form 43709(R11/6-09)•
prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: a'I i'M� 11 2 20 3
To be filed in person or by mail with the County Auditor or County Recorder of the county where the edj'Is located. Form coed with:
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought. 9 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the hie(12) Recorder
before March 31 of each year the deduction a sought.
See reverse side for additional instructions and qualifications. GIgSON COUNTY AUDIT nR
Applicant(owner or contact b(��T� see restrictions on reverse site)
a • Woe \ A t e ewS 'k- Senn lcQr �ee r mach
T''�` District �., 1e /legal description Retard number Page number
I" \Q11I' aL- n -1 (0 - 10o ooki. g (-7 - oz ) / a 3/4156
Assessed vase of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March I,anent year March 43t year date of application legal or equitable owner?
Ood ❑ Yes ❑ No
If no,what's his/her exact share 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 C donsele[
FPeeC%rDM Da n
Address of mortgagee or contract seller(number and street,city,.state,and ZIP code)
Name of assignee or other owner or holder of mortgage ^ NQI S T A-)Dec
�J
H
Address of assignee(number and steel,city,a and VP code) (�, n m4-U, Jc'1 \�s cal?-
Does applicant own property in any other If yes,what county? • W a 1'r.CIC " n property .
county in Indiana? ❑ yes ❑ No I la-3660 ❑ No
/pf Ls-' N&/ /t -3 h . GBnOth(TYAUD
Deduction approved In the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(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/contract buyer of the aforementioned property on date appflption is filed.
(ownefs MI name) Date(month,day,year)
F . eht a9cte$of (number and street�state,and ZIP code)
022 5- S foOo CJ }} /7GOe�151(/(l4G /rl .
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 street,city,state,and ZIP code) .