HomeMy WebLinkAboutMortgage_Beloat (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
_ - State Form 43709(R71/6-09)
Prescribed by Department of local Government Finance
Ile Mark
INSTRUCTIONS: 44E, i_ I
To be filed 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 file during the twelve(12)months
before March 31 of each year the deduction is sought - 'I J111*.M.,s -ecorder
See reversesidefor additional instru ctionsandqualifcations.
GIBSON COUNTY AUD • -
Applicant conbact r reverse ,e! `a itz2„.„ fl Y/ `-- Aetni-
Ta District Key number/legal description Record number Page number
(it'
R•6 -IF-351 . c'o0 - 0002 . a: '_ oa- V 2,vi 3 Lei 8I
value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract ir.debtedness unpaid as of Is the applicant the sole
1,current year March 1,anent year date of application legal or equitable owner?
es DO p El Yes 0 N
If nn,what is his/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
LYE La - -
Address of mortgagee or contract seller(n bur end street,city,state,and ZIP code) —____
Name of assignee or other owner or holder of mortgage D rawer No
Address f assignee(number and street.city,state,a�/IP code) 3 r 5 o. • /•�•• 3
�T sE 3 y 3 a Card j\1 (,I
Does applicant own property in any other If yes,what county? • What Taxing I
m •••.
county in Indiana? Yes ❑ No
COUNTY AUDITOR - _
Deduction approved in the annum of:
20 20 20 20 20_ 20 20
Signe re of Cavity Auditor / • ' County Date(month,day,year)
I/We certify under the penalty of pe rjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
ercontract r of the aforemen. S property on date application is filed.
tic natu a es ) s Date(month,day,year)
.H4
/dug resident address df applicant(number and street,city,state,and ZIP code)
r� rift 6:5- C/ /4:1?-cr. f • f-3- &a.,-te/ /n) 44 >so“ 8
Person authorized by duty executed Power of Aboney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and steel,city,state,and ZIP code)