HomeMy WebLinkAboutMortgage_Shipley STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year I
FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(RU/6-09)
Prescribed by Department of Local Government Finance
ID
INSTRUCTIONS:
ed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is loc j F
2 or
Filing Dates: I) Real Property Must file during the year for which the deduction is sought County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought ' r n le• my Recorder
See reverse side for additional instructions and qualifications. �lrTirt
Ap• ,••••y. •r or contract buyer-see an reverse side) • GIBSOth COUNTY AUDITOR Record number
Key Q Der/Legal desaiptian
'/ '0, -7-/i5o 06 %-56‘17.6L970 do/ 4(p6
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the
Match I.Caen year March 1,current year date of application or tadethowrr?
legal equitable
If no,what Is his/her exact share of interest? If owned with someone other tha��s , ❑ Yes ❑ No
spouse,indicate with whom
•
If name on record is different than that of applicants indicate below I Is ro the
(/,-[\,Jr property in question:Annually Assessed
Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seleraj
•
Address of mortgagee or contract seller(number and street/—ci y.state.and ZIP code)
Name of assignee or other owner or holder of mortgage
//
/I i /
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own in any other If county?
g/164 3 /%,
ppf property y yes,what county? • What Taring ? Has this deduction been requested on property
county in Indiana? ((((((////// for current year?
❑ Yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of.
20 20 20 20 20 20 20
Signature of County Auditor .County _ I Date(month,day,year)
J
I/We certify under the na of foregoing 1
fig tae OY perjury that the above and for of mfortnatiop ri.l pt� ---�+.N.Irdiana and
owner I contract buyer of the aforementioned property on date application is filed. // 1J--,CU4
' Sigreoue(owner's/ name)/r s • /
�-f �/ y([�//�L(/G,1C �Oc��l/��
.7, /Full resident add -: of a•• t(rnLmber •-4 • ,state,and ZIP code)
j/ /fi . b / 0760 jv 9
Person authorized by d executed Power of • -y
or by IC 6-1.1-12-0.7
Address of authorized person (number and sheet,city,state,and ZIP code)