HomeMy WebLinkAboutMortgage_Hart ��? STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year _
'- „�,,,S FOR DEDUCTION FROM ASSESSED VALUATION
State Fotm 43709(R11/609) fl / L E
Prescribed by Department of local Government Finance
File Mark
INSTRUCTIONS:
Form filed with:
To be Med in person or by mad with the County Auditor or County Recorder of the county whew{f f T77y,(i 1rted.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought ,JUN 1"/ [lJ J County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must Me 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.
Applcanl(owner cur •uyer- resvvions esr e) GIBSON COUNTY AUDITOR
Taxi • r Key number/legal description Record number Fe number
k • se 0,�i c�(o-19-St-Vco-40ao.10%- i /3 s8�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,one year March 1,anent ypfiv 60^ data of application legal ❑ ❑owner?
I,hV1 U Yes No
If no,what is his/her exact share of interest? If owned 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
- r Mobile Horne(IC 6-1.1-7)
Name of mortgagee or convect seller ��
Address of mortgagee or contract seller(number and street rdy,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street rill:Sias------
•
Dees .. A , What Taxing District? Has this deduction been requested on property . .
cunt) 0.0\ 3..... for current year? Yes ❑ No
COUNTY AUDITOR
Deduct, .....
Cali �0. --;... •
5 5 ; 20 20 20 20
j (� I I
Signature `b ,.�t County Date(month,day,
I I ce 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.
h fW name) Date(month,day,year)
ofa_� �� _
f^e�d�Qa J. t( 1xfi)rae e and pe M/ 1/7Yi39
Person authorized by duly executed Power of Mommy or by IC 6-1.1-12-0.7 a Date(month,day,year)
Address of authorized person (number and sleet city,state,and ZIP code)