HomeMy WebLinkAboutMortgage_Geuss /00-- 14:r., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Presented by Department of Local Government Finance
File Mark
INSTRUCTIONS:
with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located. Forrn Ned
Filing Dates: 7) Real Property 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(72)months
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications.
Ap�prvnt Atier or contract buyer-see rejuicbonsm1 p �7/� m'�(n 'I�9/�r�r�[
trict Key number tA/\7 DI/�,-33-aa� oo -ittiGeta
003. O'S'-DPI 1 J� PL/Z r
Assessed value ofreal gdpei;y as of Mortgage/Contract indebtedness unpaid as of Mortgage I ConUac t indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
blt050 ❑ Yes El No
If no,what is his I 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:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller e T ` Li •
Address of mortgagee or contract setter(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current year?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved N the amount of:
20 20 20 20 20 20 20
Signature of County Audis 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 contract buyer of the aforementioned property on date application is filed.
Signature(owner's NO name) Date(month,day,year)
Full I(0 1 address of applicant(number and code)r')1 , 7 o
Person authorized by dNuy executed Power of Attorney or by IC 6-1.1-12-0.7 1(f Date(month,day,year)
Address of authorized person (number and street city,sate,and ZIP code) _
fs _ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
Ai r FOR DEDUCTION FROM ASSESSED VALUATION •
%SIC.' 1t State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance (I I t in Imo.
•I1e )a ! ;.'
INSTRUCTIONS
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form fled with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. SP 1C7ura f43litor
2)Mobile/Manufactured Homes not aye-Pc-sod as Real Property Must file during the twelve(12)months
be rare March 31 of each year the deduction is sought - ❑ County�Recorder
See reverse side for=•dibonal instructions and qualifications. `,..�li
Apprcant(owne or... tract buye - - restriction revel side) � GIBSON COUNTY AUDITOR 1
T:or` , Q -0i--3 ' -dcc-Cord. �s/-oo3 2 Record U/3 P` o? Y
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I 'indebtedness unpaid as of Is the appdcant the sole
March 1,current year March 1,cement year date of appumUwy G/..ay- Jail
/ _^ legal or equitable owner?
/W/r
El Yes El No
If no,what is his/her exact share of interest? If owned with someone other tha4 spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller // JeL(
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 street,city,slate,and ZIP code)
Does applicant own properly in any other If yes,what county? . What Taring District? Has this deduction been requested on property
county in Indiana? ❑ Yes El No for current year? ❑ yes ❑ No
•
COUNTY AUDITOR
Deduction approved in the amount of ! /v
20 ' [ C G USS/�fKt� 20 20 20 —.
Signature of County Auditor / " Y J :aunty Date(month.day,Year)
I/We certify under do /3 -7:)6 v don is true and correct and that the applicant is a resident of Indiana and
owner l contract • - S.
'R•./ Date(
moth,day.Year)
1 - v6 address of t(n ambe/it/street My and LPmd/)_ ' �,LIC&7(w /,v - 76 7 0
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 llr_I{r Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .