HomeMy WebLinkAboutMortgage_Griesemer 1-Yu,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
_" S;: FOR DEDUCTION FROM ASSESSED VALUATION
," . j'c State Form 43709(R11/6-09)
S : Prescribed by Department of Lad Govemnrent Finance
File Mark
INSTRUCTIONS: nnn���eeeggg
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. ui•••i• j'i 2) Mobile/Manufactured Homes not assessed as Real Property Must 67e during the twelve(12)months before March 31 of each year the deduction is sought - •'
See reverse side for additional instructions and qualifications. AUG ry d 0 2013
Applicant(owner or buyer-see on reve a side).
OS–Taring District bee/legal desaiDtion Record nrun•:�, 'iJr,YiYYi
'6 II- I4 - lot-boo. 01D-toll GIBSO COUNTYAImITOR
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Cannot indebtedness unpaid as of Is the applicant the sole
March 1,antra year Mardi 1,i nep.yraL data of application legal or equitable owner?
❑ yes ❑ 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: Is the property in question:Annuafy Assessed
Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee a contract seller r
r
Address of mortgagee or contract seller(number an t,city,state,and ZIP l e)
Name of assignee or other owner or holder of mortgage .–– , - _ — -
Address of assignee(number and street,city state,and ZIP code)
O9 '733 18qI-Wo
Does applicant own property in any other If yes,what county? • What T P r 5 tm d..
county in Indiana? ❑ Yes �LfC
❑ No RIGA to
COUNTY AUDIT'
Deduction approved in the amount of:
20_ 20 20 20 20 20 20_
Signature of County Auditor County Date(month,day,year)
I 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.
?sfIdI name)e))jl l`^I � Date(month,day,year)
resident address of applicant(number and street. ZIP code)
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of awl-ratted person (number and street,city,state,and ZIP code) .