HomeMy WebLinkAboutMortgage_Speedy (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS rani Y 1 Whs;. Year
%,i4:,` rani J�Ui
�,;; FOR DEDUCTION FROM ASSESSED VALUATION ��
2 State Form 43709(R11/609)
"•,. Prescribed by Department of Local Government Finance
INSTRUCTIONS: AUG 2 V/
Fare Gad 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 sought • ill.ah..unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must hie during the twelve(12)month f/�./0.
before March31 of each year the deduction is sought GIBSON Co N •An ••11'
See reverse side for additional instructions and qualifications.
Apprvnt(owner or contract buyer-see restrictions on reverse side)
l..1.(1717 A 'S
Tptcrinsuic, 1 Key /legal description Record number Page number
glib-/a ag -Zo3oo a ,t7r 0078' 0701` 4/.251
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
Mandl 1,wren year March 1,airrent year date of app5caticn legal or equitable owner?
0 Yes 0 No
If n,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on rend is afferent than that of applicant,indicate below: Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of rtgagee or contract seller
TC' u -
•
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of Mortgage Drawer NO Q0.8
Address of assignee(number and street.coy,state,and ZIP code) la 56,
Card NO.
Does applicant own property in any other If yes,what county? - What Taxing V '1 ny
county in Indiana? El Yes ❑ No 1 " 416,000 I No
•
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 contrail buyer of the aforementioned property on date application is filed.
//1Siiignature(owners fi�y/a/�e��)--- Date(month,day,year)
Full resident address of appt t(nu�r and street,city,state,and ZIP code)
305 toc.se eft (7g. At /A-c.etil,. fA, 1-116 7o
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 dry.state,and ZIP code) .