Mortgage_Hancock •
e"Y!' STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'/•. .-_. t FOR DEDUCTION FROM ASSESSED VALUATION
\ State Form 43709(R11/6-09)
FILED
y„-,-'•' Prescribed by Department of Local Government Finance
INSTRUCTIONS: -
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. J UL12 2e 2013 Auditor
Must be filed with the County Auditor or County Recorder of the county where the property is located oun
on or before January 5 of the immediately succeeding calendar year. ❑ County Re • •-r
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the 4_q
county where the property is located during the twelve(12)months before March 31 of each year the •11. 19,' tiro hlr
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
nt(owner rcorbact bl("Gi-see m5 tionsdi BVB�e) I n • 1 I c„Acry
Taxing°istn'U `1\J� I Key number/legal description (/�(•/MY�/,J�j^,( if.�J —�`jV./^I('/,'/_l/ Reyord number Page number
s zb-(9-3(-*Ca-000.14A-coq( lot/ L e fia!•WOOC- /3-3 i,3
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,cungy77 f , co March 1.current year date of aig;capt coo legal or equi e owner?
/- / /� es No
If no,what is his I 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 fft.iiipdperty in question:Annually Assessed
eat Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
f'yyp Al mortgagee or contract se r I c-n -.
A(ldd,4rpss�J O/r�rmmortrt`gaaW�„Y_o`ge�or cord seller(rlymyer and sisrr sty slat and ZIP cgdCh,, ,r�s
Name of assignee or other•'owner or holder of mortgage J J(/r`/) (/
Address of assignee(number and street city,state.and ZIP code)
Does applicant own property in any other / If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? ,u�Y,"N for current year?
N ❑ Yes No y ❑ Yes ❑ No
COUNTY AUDITOR
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 egoing information is true and correct and that the applicant is a resident of Indiana and
ow /contra uyer of the aforementioned operty on d- e .pplication is filed. y
sgremr s 1u n me) _� [/ Date(month. y,year
c
'7 �(a--�d0 Li
Fu resident address of applicant umber and street,city sr e, rid ZIP e) i-7(039
Person authorized by duty executed Power of Attorney or by I 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,state,and ZIP code)