HomeMy WebLinkAboutMortgage_Powers STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coup I�wnED Year
-: FOR DEDUCTION FROM ASSESSED VALUATION
t State Form 43709(R11/6-09)
Presaibed by Department of Local Government Finance -
File Mark
INSTRUC17ONS: t r
oim -I:, r
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. Cou Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months / 'I 1 e/
before March 31 of each year the deduction is sought - gi-r?'!t Recorder
GIBSON • •
See reverse side for additional instructions and qualifications. ' . -
Applicant(owner orcontract buyer-see restrictions an reverse side)
Taxing pP( ' RA-" Key number`���1 option _ �� f � Record number Page number
CS. 1 , - l?y- l3 •yo3 - Cbbt 9ya — on Co a0 13 3c043
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,arrest year March 1,anent year date of application legal or���egq...u,,,it""""able owner?
a fs y op a ty�yes ❑ No
is If no,what his/her exact share of interest? If owned with someone other than spouse,indicate with whom II
If name on record is afferent than that of applicant indicate below +s�'i property in question:Annually Assessed
'-C Property ❑Annually Assessed
Mobile Home(1C 6-1.1-7)
Name o�mortgagee a contract seller
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 and street,city,state,and ZIP code) _ _
Does applicant own property in any other If yes,what county? • What Taxing District?
county s Indiana? ❑ Yes `ek° I llI'a wet 1\10..
COUNTY AUDITOR Card
Deduction approved in the annum at i\'0 �( . .. ....
20 20 20 20 20
I
Signature of County Auditor County Date(nonik mr,.- .
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 aforementioned property on date application is filed.
Signature( Date(month,day,year)
F resident address appfoanl(numbe�stree t,city,state,and ZIP code)
/`�3 ' S R S`7 dA1rL,4fr4L/ 7y 7A{ `} 76 lac)
Person authorized by duty 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,end ZIP code) .