HomeMy WebLinkAboutMortgage_Mans STATEMENT OF MORTGAGE OR CONTRACT prirE ounty Township I Year a` �ec: FOR DEDUCTION FROM ASSESSED VALUATl:C State Form 43709(R11/6-09)
:`.. Prescribed by Department of Local Government Finance
INSTRUCTIONS: JUL 1 2 2013 File Mark
Form Ned with:
7o be filed in person or by mad with the County Auditor or County Recorder of the county where the props is I ted.
Filing Dates: 1) Real Property Must file during the year for which the deduction is song County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must 17e� 2)months
before March 31 of each year the deduction is sought County Recorder
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GIBSON' COUNTY AUDITOR ty
See reverse side for additional instructions and qualifications.
Applicant( buvenee restrictions on revs e)
(\. . _a rQ , (! �7 Record _pet/ number,/
Tarir,45Tbtript ,.k_ ^ Key comber/legal de ipya' //—/5—qoo—ooa-ooT . co ` azo /3 Pie '3. aq9
Assessed vatic d real prc er y`X'y as/,76,yfJ/, Mortgage//C/Conl/nttract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Month 1,anent year March 1,cement year date of application legal or equitable owner?
(1(C)Doi ❑ Yes ❑ No
If no,what
is his/her exact share of interest? I f 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
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller (1 /1 i1 C
Address of mortgagee or contract seller(number and street city pstaate,,)and/1ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city state,and ZIP code)
Does applicant own property in any other I If yes,what county? • What Taring District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for anent year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature d . Audito/r County Date(month,day,year)
V
I 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 I contract buyer of the aforementioned property on date application is filed.
Signature er's full name) Date(month,day,year)
F • tktlress ofa Ct(numberard t. t and ) ^n 5t7�
3 cc,,of lam/// 7�
Person authorized by they executed Power d or by IC�1.1-12-0.7 � Date(month,day,year)
Address of authorized person (number and street city state,and ZIP code) .