HomeMy WebLinkAboutMortgage_Kell STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Of`.f' r FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of local Government Finance
Fit-
INSTRUCTIONS: '?
f,al1.R!nP.':!
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought _ County Auditor
2) Mobile/Manufactured Homes not ate-Posed as Real Property Must file during the twelve(12)monthsAU G 1 O 1
before March 31 of each year the deduction is sought - unry Recorder
See reverse side for additional instructions and qualifications.
Appfnan acontracr buyer- restrictions reverse site) /
�/�.a�-C����C��� �� e e �J 3 /t GIBSON COUNTY AUDITOR i
Ta ' / Key number/legal description Record number Page number
,t� Flo - le? -/ 9 - ao3 - 00% a36 - oa 6, l3 3 iO3
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,anent year date of application legal or equitable owner?
13a 000 El Yes 0 N
If no,what is his exact I her ect sham of interest? / n 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
Moble Home(IC 6-I.I-7)
Name of mortgagee or contract seller G - - -_
Address of mortgagee or contract seller(number and sheet city.state,and ZIP code) I s C -
Drawer NO.
.l
Name of assignee or other owner or holder of mortgage 2 '•'""••••
•
Address of asst ee(number and street,city,state,and ZIP code) Card NO. . ./O
7, e.c� d 9 ./q S h CC»
Does applicant awn property in any other If yes,what county? . What Taxing DIstncei
county in Indiana? ❑ Ye5 ,_,
❑ No I .__
COUNTY AUDITOR
Deduction approved in the annum at
20 20 20 20 20 20 20
Signature of ty Auditor County Date(month,day,year)
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
QZ,XJt&tYf r/contract bof t/e afore entioned property on date application is filed.) / r, Date(mmtA,day,year)
A.,_ Fc��t &�\(�1m / d l a � 1 IN 2—I-7/12Ljg
Person authorized by duty coed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and sbee4 city,state,and ZIP code) .