HomeMy WebLinkAboutMortgage_Oldham f , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
" FOR DEDUCTION FROM ASSESSED VALUATION •
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State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the prope 1 t I F n.n j�_
'
Filing Dates: 1) 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!we 2)months
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications.
JUL 2 z !
Applicant(owner ot contract b -see . ' on reverse e)
r/y—�_Tt b4
Taring District number legal d Lion � lT e number
6- /d -a� -30() - 00) . �1? -pa GIBSON C X 39?0
Assessed value of real property as of Mortgage/Contract unpaid as of I Mortgage/ indebtedness unpaid as of I Ls the applicant the sole
March 1,current year March q D U 4o I date of application legal or 'bsk
U_lf 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
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller •
•
Address of mortgagee or contract seller(number and cifl:state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city.state,and ZIP code) n
Does applicant own property in any other (� ' (pQJ yam„,n - Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No (_ &A ran r 1 far cement year?
❑ Yes ❑ No
Drawer NO..2013
Deduction approved in the amount of: 3(� O
Card NO. `If
20_ .-20 ll `� ,�1 20 20
Signature of County Auditor • �'1 U UCounty Date(month,day,year)
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
Amer I contract buyer of the aforementioned property on date application is filed. /
Sig full ) '„ Date(month,day, i
_ ?/y 41(20/3
F dent dress o a scant(number and t,city,state,and ZIP code)
authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sine;city,state,and ZIP code)