HomeMy WebLinkAboutMortgage_Peil . . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
I!t State Form 43709(R11/6-09)
Prescribed by Department of Loral Government Finance
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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. Form filed 7 ��1�
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. S� £duntyAAllbitor
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. - . County R-•• •-
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See reverse side for additional instructions and qualifications. Fannin,
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Ap. eyr(owner or contract buyer-see restrictions on reverse site) � GIBBON COQ • - -
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Taring Distill / Key number/legal description Record number Page number
}4/ r 2-l0 -oa -59 - 03,2 - coo• v67 9-oi9 /3 t/ if i3
value at real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage 1 Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,current year date of application legal or equitable owner?
di 1, `J7.lo. 7h ❑ Yes 0 No
If no,what is his/her exact share of interest? If awned with someone other than space,indicate with whom
If name on record is dhten ant than that of applicant indicate below: . _ Is the property in question:Annually Assessed
__ ,— —4�ronv_0 Annually Assessed
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Name of mortgagee or contract seller 4te.L•
Address of mortgagee or contract seller( ZIP code) 1� ' 1 N( )t D Pat
Name of assignee or other owner or holder of mortgage I _ - f
Address qt assignee(p.ynber and street c%state,and ZIP code) M ��I�
(Z S
Does applicant own property in other If yes,what county? • What i 6_at] cola,. /y IC y
county in Indiana? ❑ Yes •) '/ /V,/•
❑ No / No
COUNTY AUDI' -61 !,L` i3RNk
Deduction n approved the amount of: n (� U J
20 20 20 20
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, - -
Signature County • County I Date( mfi,day,yew)
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/contract buyer• - aforementioned property on date application is filed.
k sg o n 9
Date(moon,day,year)
� /Full 7en� P"'� S( ymberard street pry state./elafra V7‘YO
Person authorized by duly executedd Power of Attorney or/by IC 6-1.1-12-0.7 ,T-A.)
Date(month,day,year)
Address of authorized person (number and street dry,state,and ZIP code) _