HomeMy WebLinkAboutMortgage_Nelson (2) M f�.. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
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INSTRUCTIONS: t
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought ) County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)most& 1 D Ziii County Recorder
before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications. jlinvatir
Applicant( r or tract buyer-see V �on tse side)
U 4 n?7Z e) 7eA 't- GIBSON COUNTY AUDITOR
Taring D' Key number/ I description Record mutt Page number
Assessed e d real p , as of Mortgage r Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
So O D (7 ❑ Yes ❑ No
If rro,what is his I her exact share of interest? If owned with someone other than sp6use,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(IC 6-1.1-7)
•Name of mortgagee or contract seller
•
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Address of mortgagee or contract seller(number d street,city state.and ZIP code) Jilt I � -{ �r " r
Name of assignee or other owner or holder of mortgage 1(�. c �l[,(/
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Address of assignee(number and street dry,state,and ZIP code) �q 'L pJ
AO KT+' /JT/✓3
Does applicant own property in any other If yes.what county? • What Taxing District? Has this deduction been requester'on mWv.i
county in Indiana? ❑ Yes ❑ No for parent year? ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved N the arrant of:
20 20 20_ 20_ 20 20 20
Signature County Auditor . County Date(month,day,year)
I I We certify under the pe arty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
` / owner contract buyer of the aforementioned property on date application is filed.
X Sigra "a hull ) Date(=Mil,day,Yuan)
I , Full y+ • . I(numbe and sbe€t,aTy,state,and ZIP code) — C
`Y" al9 � -) J
P: n authorized by duly executed of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry,stare,and ZIP code) .