HomeMy WebLinkAboutMortgage_Gollnick (2) S STATEMENT OF MORTGAGE OR CONTRACT I1 NE E County Township ,year
FOR DEDUCTION FROM ASSESSED VALUATI®41 Tt State Form 43709(R11 1 6 ) 1 Presaibed by Department of Local Government Finance
OSFile Mark
TRUCfONS: AUG 2 2013
Wbe filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Font filed
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is song County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must fi (12)months
Ye sought GIBSONCOUNTYAUDITOR ❑ County Recorder
before March 31 of each year the deduction is ht.
See reverse side for additional instructions and qualifications.
Applicant(owner or r-see on rave stl
U�a� o-llx c Y�J
1(.y't,. ri ' I 1V Key number 1, Ict (9 s '^� Mb.OSb-6b9 Record nun
Page ic_7
cc," •value of real property as of pMortga�age/Con tedness unpaid as of Mortgage I Contact indebtedness unpaid as of {I Is the applicant the sole
ag
F• 1,asrva year March 1,ax date of application legal or equitable owner.?
aop0(� ❑ yes 0 N
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 t f/.s�k\
Address of mortgagee'_._- �'{�111.=./) ____—._.._.,..__
Name of assignee or o '
Drawer NO.../3.
Address of assignee(t •.
Does applicant r Card NO. ..3 � what Taxing District? Has this deduction been requested on property
my Indiana? for amen ❑ No
ED Yes
4UDROR
Deduction approved in the amount of.
20 20 20 20 20 20 20
Signature of County 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
owner I contract buyer of the aforem�t9�ed propertyy oond at/tee application is filed.
retxlre hArA7��<y/2's! (f�� Date(month,day,year)
addressV/of t�t((n/�umberand street city,state,and ZIP code) ` R }(l �?
Pelson authorized� duty extol., o;Aaane�Miif.t-1211.7 //I[1557742)r 'I % 7 37
Address of authorized person (number and street city,state,and ZIP code) .