HomeMy WebLinkAboutMortgage_Fuhs (3) 4 _ STATEMENT OF MORTGAGE OR CONTRACT i �WESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATI®A11'
I'. State Form 43709(R11/6-09) .�
2" l
Preen-bed by Department of Local Government Finance
File Mark
INSTRUCTIONS: JUN 2 7 2013
To be filed in person or marl with the Court Auditor or County Recorder of the count where the ro Pow Nom `
Pe by b ry 1 P Pentalocated.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is so
County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must months
before March 31 of each year the deduction is sought GIBSONCOUNTYAUDITOR County Recorder
See reverse side for additional instructions and qualifications.
App5cant(owner or con b see rare side)
� a C2Dl3 a0-77
�utwt Key number/legal desaip Record number Page number
�// -- o lo-OS- S7 D83—Oo3 -c c-o/7
Assessed value of real proper//as of Mortgage/ ct'v�debtedness unpaid as of Mortgage!Contact indebtedness unpaid as of Is the applicant the sole
March 1,current year March I.an t Je6rl 8 date of application
legal or equitable owneR
❑ Yes El 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
/�Q ^ (9e.. fp Rea perty ❑Mnually Assessed
U // l�/r� Mobde Home(IC 61.1-7)
Name of mortgagee or contract seller �DD��
.tiIP
Address of mortgagee or contract seller(number and street,ray:state.and ZIP code)
Drawer NO x013
county? - What Taxing District? Has this deduction been requested on property
y��y for current year? ❑ Yes ❑ No
- Card NO. ...c9/ /7
4 /.3g, rmse(72 COUNTY AUDITOR
20 20 20 20 20 20 20
' Sign ry aor County Date(month,day,year)
CSC/ '
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 application is filed.
nature( rs ruff name Date(month,day,year)
z:$ D1. -
ull resident address of applicant(number and street,tray,state,and ZIP code)
2G 30 East Skate toad lib I-'k telt'oln T/J y-icLIO
Peon authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 /
rs Date(month,day,year)
Address of authorized person (number and sbee4 city,state,and ZIP code) •