HomeMy WebLinkAboutMortgage_Johnson (16) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
:;_` , I: State Form 43709(R11/6-09)
;.,-. Prescribed by Department of fatal Government Finance •
INS7RUCT7ONS: .111121111
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. O�p11'-'__'-11I1,, 1C�ounty Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months AUG U 11 Q Gbunty Recorder
before March 31 of each year the deduction is sought - LLJT
See reverse side for additional instructions and qualifications.
Apo/ant(owner or contract buyer-see ..ors on reverse side) GIB SON COUNTY AUDITOR
Dis —} CYy/ nmther/legal description number Page n
alo -/a-o? - yo/ - DIM. 1196 - o1- F /,3 .c r6‘
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of! Is the applicant the sole
March 1,astern year March 1,current date of application legal or equitable owner?
`t t S'D O ❑ Yes ❑ No
If no,what Is ha I her exact share of interest? / If owned with someone other than spouse,Siesta with whom
If name on record is different than that of applicant,indicate bebvn Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Home QC 6-1.1-7)
Name of mortgagee or contact seller a `--'t,. c ,
Address at mortgagee or contract seller(number and street city,state,and ZIP coda)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
D
. / T 5E "7 - J1 - /0 . /i4-C_
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
cwnry in Indiana? ❑ Yes ❑ No for current year? ❑ Yes ❑ No •
COUNTY AUDROR
Deduction approved in the amount of
20 20 20_ 20 �-y�
Drawer NO...sa)1.3 _
Signature of County Auditor County (�/�/,,/' ,, r
s • = Card NO. `0(e(! —
I/We certify under the penalty of perjury that the above and foregoing information is .
owner/contract buyer of the afore entioned property on date application is filed.
A...-Sig (owne •name)
S ' • I
3251 S. , qcE (number
iPR Al street, To1`(r ZIP code) 9i74. 7a
Person authorized by duly executed Power of Attorney or by IC 0-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and steer,dty state,and ZIP code) .