HomeMy WebLinkAboutMortgage_Ellerbrook ' OR DEDUCTION STATEMENT IO F MORTGAGE ES OR CONTRACT S County Township Year
' � FOR DEDUCTION FROM ASSESSED VAL
State Form 43709(R11 1 6-09)
Presaibed by Department of local Government Finance
File Mark
INSTRUCTIONS: AUG 2 0 2013 Fpm,Ned with:
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 so ht County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must r du' (12)months County Recorder
before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or contract uy r- restrict'o on reverse side )
,17)6 Ate4 Key number/ description Record intber Page number
423- 3.0o-O�•S'o5-oa ots 4#o85
Assessed vatic of real popery as of Mortgage C!po/]t indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the eppiMt the sole
Mardi 1,Mere year March 1,ou$tr-O�O date of app6caaon legal or equitable owner?
��/ J ❑ Yes ❑ No
If no,what's his I her exact share of interest? J If owned with someone other than spouse,indicate with whore
If name on record is it fterent than that of applicant indicate below: Is the property in question:Annually Assessed
❑Real Property ❑AnnuanyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller / • 9 n
Address of mortgagee or contract seller(number and (street,city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number end street,city,state,and ZIP code)
Does applicant win property in any other I If yes,what county? • What Tatting District? Has this deduction been requested on property
county in Indiana? - ❑ Yes ❑Noo for=rent year? ❑ Yes ❑ No
—
COUNTY AUDITOR
Di
— frawcr 0' 20
20 20 20
sign Card 1'0 ,,
• •• .L0 County Date(morh C r)
• r d
c?013
_`,
I/ _ ,,,perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
TA__-r- __.,,.ea buyer of the aforementioned property on date application is filed.
Signature jpirves hi name) Date(month,day,year)
).O .421, ,4. �gg - 1
Full resident address of a t(number and street city,state,
and P code)
CO r8 741-0N• ,-9.2.5" >,c) • Ptr9
2, - , 1 , . 476 66
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) .