HomeMy WebLinkAboutMortgage_France � . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CounrN15�'.� St fl ear
Gide FOR DEDUCTION FROM ASSESSED VALUATION p: It State Form 43709(81116-09)
Prescribed by Department of Loral Government Finance
SE e$4 k2013
INSTRUCTIONS:
M be filed in person or mail with the County Auditor or County Recorder of the county where the property Form Ned
Pa by h h h P Pent k located.
Filing Dates: 1) Real Property Must Me during the year for which the deduction is sought. 1. .� f�rnd�•• dilor
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 GIBSON In NSolGrlAftafi raR
See reverse side for additional instructions and qualifications.
Appf (owner or contract buyer-see bicnwrs on reverse side)
.0 isL ¢J�KKeeyy number/legal desaip' Record number Page n
111x1 ] -_ - , d - % ' - ►'D-•._ 3�-aa l3 -tat
••,........,.value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the appficant the sole
1• 1,ctrreel year March 1,current year date of application legal equitade owner?
53ooa Yes ❑ No
If no,what's 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
IQeel Property ❑Annually Assessed
T Mobile Home(IC 6-1.1-7)
tcof mortgagee or contract seller
y
Address of mortgagee or inn 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,my-state,and ZIP code)
Does applicant own property in any other If yes,what county? . What Taxing District? I Has this deduction been requested on property
county in Indiana? ❑ Yes JO _ _ _ __ far ant Sean r�{{t-��ea
r��/j� ❑ Yes Lino
COUNTY AUDROI I�f l,a Ai c 6 CCV,o se 1
Deduction approved In the amount at STER144 u #-
20 20 20 20 I /3— 72 (p _
Signature of County Auditor County l�
I/We certify under the penalty of perjury that the above and foregoing information is true and tai...._._ and
owner I contract buyer of the aforementioned property on date application is filed.
Signature(o'tn"ts fib nom Date(month,day,year)
L(reS 14ty F/4A(p Q - cr
F resident add of a (number and street city,state,and ZIP code)
Ce9111) S. ((e4.utew 10/. Nscwls/4Ji 14/ 4 639
Person author zed by duty executed Power of Attorney or by IC 6-1.1-12-0.7 r Date(month,day,year)
•
Address of authorized person (number and street city state,and ZIP code) .