HomeMy WebLinkAboutMortgage_Harper STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ter,;; FOR DEDUCTION FROM ASSESSED VALUATION TT
ail--: f,' State Form 43709(RU/609) � rt
Prescribed by Department of Local Government Finance 'fgeil-
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or Court Recorder of the county where the property F �q nd trite.
N County ty P Pe b s located. a �I1�
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought 3�ratiauditor
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 1 ❑ County Recorder
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See reverse side for additional instructions and qualifications. GIBSON
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Ape/mayowneror contract buyer-see restrictions 000rrr///e`erse/da) N1YAU
AUDITOR
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Taxing District Key number/ description Record number Page number
Q 4,ee.,--e--d di- ?4 - i v-/S - elm/ -moo. a 55 0 0 7 d.013 39 0
Assessed value of real property ff Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the ape/sant the sole
March 1,arrant year March 1,anent date of apprmation legal or equitable owner?
Qooc ❑ Yes ❑ No
If no,what is his I her exact share of interest? r 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 quesuan:Annually Assessed
❑Real Property ❑ArmuanyAssessed
• Mobile Home QC 6-1.1-7)
Name of mortgagee or con weer
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Address of mortgagee or contact seller(number and street,eery,sate.and ZIP code)
Name of assignee or other owner or holder of mortgage -
Add f - nee(number and street,c i t y,state,and ZIP code) - -
� � CLLR-oL .5 rz� C)--
Does applicant own property in any other If yes,what county? - What Tarring Diatict? 05o I
Indiana?
❑ Yes ❑ No D
county m lnd i'a ye1- NO,,,t...• 3
COUNTY AUDITOR 9 /'1
Deduction approved
In the amount or. Ca rd j No. ... 3 1 `/
20 20 20 20 20 i (00/000
I I
Signs of County Auditoc • r . County Date(north,day,year)
I We We certify penalty of perjury that the a above and foregoing information is true and correct and that the applicant is a resident of Indiana and
I con... buyer of the aforementioned property on date application is filed.
A,-7 ,rs rue.- .ems Date(month,day,year)
um-lint address of t pu r and street state,And ZIP )
--7/ N. �, _ , ek, y . 7G�o
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(nridh,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .