HomeMy WebLinkAboutMortgage_Pride STATEMENT DU IO F MORTGAGE OR ED VALU CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VAL A @gI J yN�E
r'' - State Form 43709(R11/6-09)
• a=v: Presented by Department of Local Government Finance
File Mark
INSTRUCTIONS: S E P 1 9 2013 Form filed with:
To be fled in person or by mail with the County Auditor or County Recorder of the county where the property is located.
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 Burin a months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant( barlb r-see re.strictiajon re side)
T g� Key raanber/Icga 1L — /7100-2 vv- 6255-a, Record rwm9 Page er70
Assessed�v hue doff re_all property as 4 Mortgage f Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of�/'{Is the applonnttt the sole
Marts 1,anent year March 1,ca date of application legal or equitable owner?
(od00 ❑ Yes ❑ No
If no,what is his/her enact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is Off erent than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller 'I��� Q P' - - a / ' .-cam l
Address of mortgagee or contract seller(number and AellAll
e,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 Taring District? Has this deduction been requested on property
county in Indiana? El yes ❑ No for current yeaO ❑ yes
❑ No
1 144-# '1NTY AUDROR
Deductionrapwowd'-�'—`rywr' _� 5 A 1 20_ p, �r J j.5 20 20 20
Signature �Jr ( County Date(month,day,year)
13-4UXr
I/We ce 'ormation is true and cooed and that the applicant is a resident of Indiana and
�`S/(7 Owner/c ,t , , _....are application is filed.
F Ia� frk„ i) Date(month,day.year)
erg resid nt address of applicant(number and street cry,state,and ZIP code)
!612( ()JQsf 'Dr. n'tland Ct k( ,T,J Y7(,46
authorized by duty executed Power of Attorney or by IC 6-1.1-12-0. Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .