HomeMy WebLinkAboutMortgage_Martin (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
fa'? FOR DEDUCTION FROM ASSESSED VALUATION
,r•'. `'t" State Form 43709(RU 16-09)
> Prescribed by Department of Local Government Finance - -
INSTRUCTIONS: f /EM I
•:„.,i7, .
To be filed in person or by mail with the CountyAuditdr 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 sought. Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months A
before March 31 of each year the deduction is sought. MI)
Recorder
See reverse side for additional instructions and qualifications.
Ap t(owner or contract buyer-see restrictions an reverse side) /J GIBSO COUNTY AUDITOR
p� Qi�z �JijC �Zcim e vJ 7 `j yt �
T DC ic r-�•' Key number/legal description Record number Page
3y- woo - ooa .d93 -odq 2n13 /e
z6 -a-
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
1,once year March 1,amen year date of application legal or equitable owner?
/O tf n o d ❑ Yes ❑ No
If no,what is 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 6-1.1-7)
Name of mortgagee or contract Seger S, , /� �_l
Address of mortgagee or contact seder(number and street, ,state,and ZIP code) C J\
Name of assignee or other owner or holder of mortgage
AddreAs of assignee(number end street,dry,state,and ZIP code)
Pt se 3Q - 3 -ir d . l4y A- c---
Does applicant own property in any other if yes,what county? What Taxing Diste-n. __ _I Has deduction been requested an property
county in Indiana? _
❑ Yes ❑ No _❑ Yes ❑ No
COUNTY AUDITOR Drawer r _
Deduction approved N the amount of: ,
_
20 20 20 20 Card NO
•Signs of County Auditor • / h County /D�U I (06 •••••••••• —
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 mule.--.._ -
owner/contract buyer of the aforementioned property on date application is filed.
X Sig (owner's tuft name) Date(month,day,year)
/ ' Cam= t C en.&=
/Full resident address of applicant(number and street city,state,and ZIP code)
� ) a2N„Zl -Ies4- /o,2-C Sd,ir1. Far f- &i>✓c.i-- y,A ci76Y
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 ` Date(nprN1,day,year)
Address of authorized person (number and street,may;state,end ZIP code) .