HomeMy WebLinkAboutMortgage_Maikranz A: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township fl
- ;, FOR DEDUCTION FROM ASSESSED VALUATION
-&:!. -. State Form 43709(R11/6-09)
('`e l Prescribed by Department of Local Government Finance =it M
®INSTRUCTIONS: .. .e 6 i' .'
To be filed in person or by mail. Form fled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. AU G ,+1n,1 Auditor
Must be filed with the County Auditor or County Recorder of the county where the property is located ❑ 4048,
Auditor
or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the
deduction is sought GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buy r-see resin ns on reverse side)
TES/1 U/J �- Jf S•s/cy 2. �i9'y/e/to, A/2-
Ta>;rtgDisjrict� Key OUmber/legal description Record number Pag'n/ bee
Assessed value of real property as of O/(,() Mortgage/Contract indebtedness unpaid as or Mortgage/Contract indebtedness unpaid aslof Is the applicant the sole
March 1,current year March 1,anent year date of application legal or equitable owner?
/V3/ liw�i• p0 0-Yes ❑ No
It 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
areal Property ❑Annually Assessed •
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sell r
C7)C;177-1 a 2 f '"s //9o,riz 9a r 7/t
Address of mortgagee or contract seller(number and street,
ci state,and ZIP coda)'9So S/<>71 4/N-7,72,.- fr ler ✓/y
4✓£1-7 Dt/vL S77 2 Z 2 /40J4s'7-Poz,fZ ,-7/o 22/
Name of assignee or other owner or holder of mortgage
a j
Address of assignee(number and street,city,slate,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property a
county in Indiana? �0 for n year?
yea
❑ Yes L7 ❑ Yes • 9-110
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 foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature(comers full name) Date(month,day,year)
Full r*eri address of applicant(number and hity,city,state,and ZIP code)
/a eh AP E, /747/// r771 rr; Dgxcrvo Cr/Ty 1t/ 5/7Goo
Person 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 street,city,state,and ZIP code)