HomeMy WebLinkAboutMortgage_Hormuth Ntr'�o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township 1 Year
-e FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
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`• Presuibed by Department of Local Government Finance I,�gpt{
INSTRUCTIONS:
To be filed in person or by mail. Form liI ri
Filing Oates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. ~ 0 013
Must be filed with the County Auditor or County Recorder of the county where the property is located ❑ County Auditor
on or before January 5 of the immediately succeeding calendar year. Lou er
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 GIBSON COUNTY AUDITOR
deduction is sought.
See reverse side for additional instructions and qualifications.
AD cant(owner or contract buyer-see restrictions on reverse side)
IHattl{nPIA) P, rmu
Taxing District Key number/legal description /, u f'SO.; R4 MO SC Record number Page number
-)0-3(0-.(()-not. 357 CUB / r 367.9-n- 8013 yHg&
Accessed 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,current year March 1,current year date of application legal or equitable owner?
AN ,000 ❑ Yes El 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: st property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgag oir contracts ler
Top 1lN( Inainua ( InC,
Address of ortgagee 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 and street,city,state.and ZIP code)
1 Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana?
ElYes El current year?
Yes LyJ No Yes ❑ No
1 / \ COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor 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 I contract buyer of the a rementioned property on date application is filed.
Signer full name) Date(month,day,year)
Full resident addr of pplicant(numb pr and street,city,state,an IP code)
4033 17oo i,J , owwen5UiI1elkS X7665
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-U.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)