HomeMy WebLinkAboutMortgage_Maglis STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.
. ;_ FOR DEDUCTION FROM ASSESSED VALUATION
=u" li State Form 43709(RI1/6-09)
:.4,1, Prescribed by Department of Local Government Finance f ((L{}
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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 local . Form Ned
with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. E P U M13 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought. - ❑ Cou Recorder
See reverse side for additional instructions and qualifications.
?(owner or contest buyer-see . . on reverse side) 0 GIBSON COUNTY AUDITOR
d
Tad indict Key number/legal d tan Record number Page number
ollc - /01..0 - Joa ^000 , 70e- 61- e /3 yasy
Assessed value of real property as of Mort gage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
MazM 1,and year March 1,current year date of apprrca' D legal or equitable owner?
p 700 D Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other thanfspouse,indicate with whom
If name on record is different than that of applicant.indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller + F
Address of mortgagee or contract seller(number end street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage 11(164-1-3 /�
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Address 1 assignee(number and street,city's: ,and ZIP code) A
Does applicant own property in any other If yes,yes,)what county? • Mu on property
county in Indiana?
❑ Yes ❑ No ./3 —ydsy a ❑ No
COUNTY AUL.
Deduction approved in the annum of:
20 20 20 20 20 20 20
Signature of County AUCytor . County Date(month,day,year)
I I We certify under the penalty of pegury 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.
KSignature(owns hull name •- Date(moth,day,year)
�// a�, P 1-9-13
/� Futl resident add 6 b 7 6- e� 6r1✓� �P code), , Lung 47b 7 o
��, 111 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 sheet,dry,state,and ZIP code) .