HomeMy WebLinkAboutMortgage_Young (2) °•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS QKoual, ��jj ip }ear
FOR DEDUCTION FROM ASSESSED VALUATION �'
' ,_ State Form 43709(R11/6-09) „(�
mss Presumed by Department of Local Government Finance AUG
flpINSTRUCTIONS: 17 5 Q13e Mark
To be filed in person or by mail. Fo tiled '+
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is so
Must be filed with the County Auditor or County Recorder of the county where the property is to County Auditor
on or before January 5 of the immediately succeeding calendar year. GIBSON COUNTY AETTITaiiitltyRecorder
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
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see resbi n reverse side)
Taxis�p/istrict/iy,,,, -_ _ Ke n ber/legal description O� ecord number ,/ Page number
v eVCO eor Na 37176.✓ 77�/—A1, afc,a S.nii7lr/fj�p/✓ j_3-T197
Assessed value of real property as of /( Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
. March 1,current year March 1,current year date of application legal or equitable owner?
`_ ,f/ 530- 0 O Dice ❑ 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 IIss-the epproperty in question:Annually Assessed
Rrceal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
N f mortgagee or contract s ler -
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
y.5?) S 7/ !144717 1✓EZ 79-4e 4097 & IftD.t C7c zz t 1ii/g,, 970a ca /6,2.2/
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
so
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county In Indiana? ,—,C for current year?
❑ Yes I�No y ❑ Yes [3' o
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Au`Auditor gr 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(owner's name)
Date(month. ay,year)
1' 1111
�,MA� • _ 07��s�a/s
Full resident a dress of applicant(number an. . -et,city,state,a code)
fey A/ es/ y _ 0 iv.d. S✓/u f 7,...,— `f7GG .-
Person authorized by duly 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)