HomeMy WebLinkAboutMortgage_Whipkey a1 a�. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance a
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INSTRUCTIONS:
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: f) Real Property:Must file during the year for which the deduction is sought. )^,p
S E P 3 unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months Q
before March 31 of each year the deduction is sought &aunty Recorder
See reverse side for additional instructions and qualifications. 7/ —•
nt(owner Of contract buyer-see restrictions on reverse side) GIBSON COUNTY AUDITOR
/n_ ' I ' '' 9�
Ta 7 istict / Keynumber/legal 1 �,�`( Record number P e number
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Assessed value of real propelyy s of Mortgage/Coniraa indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
Mann 1,current year March i,curtenl year date of application legal or equitable owner?
H a, 0 0 0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than ywma,indicate with whom
If name on record is dfterent 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 mortgagee or 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 steel ot) state,and ZIP code) I` \
. „l HSPKcy 2cv3 oar D
Does applicant own property in any other If yes,what county? i What Taxing Dis Pear
county in Indiana? El Yes El No in) /�,7 _
COUNTY AUDITOR /3 -,3I35
Deduction approved In the amount of:
—
20 20 20 20 —
II Sign County As ` County Date(month.day,year)
I 1 We certify under the penalty of perjury that the above and foregoing infomration is true and correct and that the applicant is a resident of Indiana and
owner II contract buyer of the aforementioned property on date application is filed.
/ recCs F/urgod ^p'�y� Date(month,day.year)
Full resident address of applicant(number and sleet dK;state,and VP code)
36 q &fyr a0o so,47yl, P,-Ih c<ron 1.0 q 76 70
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,and ZIP code) .