HomeMy WebLinkAboutMortgage_Sturgeon STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co 70
�.= �.•, p Year
S.;: FOR DEDUCTION FROM ASSESSED VALUATION 0–i A-1
"` -- State Form 43709(RH/6-09) .a JLJ B i
Presoibed by Department of local Government Finance •
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INSTRUCTIONS: AUG Fjle4"Lui3_
Form mad eft:
To be filed in person or by mail 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 • WI •,;i. • •t ditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months ' la:'inlet ray RR
before March 31 of each year the deduction is sought - GIBSONCOU'' Y •1`UITOR
,, _ �aiYe�s�hirD�rS}'n reverse sQit�e�¢)'y^[,/ /1 � ,//� (j �///
i/ .e ,C (`? `Y/✓�I /D d O� .3`'0_ ocfl / Ram�/��'Oe V 70 /
Assessed vahm of real , as of Mortgage/Contract indebtedness unpaid as of Mortgage/Corm-act indebtedness unpaid as of Is the appfncent the sale
March 1,=rent year March 1,cement year date of legal or equitable owner?
/ ❑ Yes ❑ No
If no,what is his/her exact of interest? If owned with someor(e other than spouse,indicate with whom
If name on record is different than that of app&ant,indicate below. Iss property in question:Annually Assessed
Real Property ❑Mbile Home Mobile H
ome(IC 6-1.1-7)
-
Name of mortgagee or contract setter 7 _ / / / .
•
Address of mortgagee or contract seller(number and street /ay`.statg and ZIP code)
Name of assignee or other owner or holder of mortgage
-
Address of assignee(number and street city,state,and ZIP code) 4/ �/ J / /-/O / ^9 2�
Does applicant own property in any other If yes,what county? - / C/WWha.at'faxing [Dstrict?T[/_ Has this dedu taunt/been requested on property
ammo,in Indiana? ❑ No for current year?
❑_Yes ❑ Yes ❑ No
COUNTY AUDITOR
Der Drawer TO
20 20_ 20 20
Card NO. ...�: 6 1 7��-7 I
& •............ County Date(month,day.year)
I/We certify under the penalty u.1,.,.,_, )regoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property oil u....application is filed.
lure(owner's full name)/ Date(month,day,year)
Oil / �i {�-ate-.. �7 �7
ull resident address of app E�caanntt((numbera street city staatte/,and ZIWdede)
,t 70���T/27 C—aJn— A ' O ie42 e e c'c-,1-GC-
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authored person (number and roue;oily state,and LP code) .