HomeMy WebLinkAboutMortgage_Everett STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County LIEb ownship Year
_ . � I FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R71/6-09)
Department d Lnml Gnrent Fuance k
INSTRUCTIONS:
To be hied in person or by mail with the County Auditor or County Recorder of the county where the property is located. DC F L a�
[
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. fl County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must 117e during the twelve(12)months
before March 31 of each year the deduction is sought - ,/// Femrder
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
AppG n t(owner or contract buyerq-7 restitutions reverse side)'"�'�
Ta District Key number/legal description Record number Page number
o>J 2,4, - 011.441- 3Go- oo0. 475 - 0 )._y / 9&
ea valued real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applcant the sole
March 1,carrot year March 1,anent year date of appGmton legal o equitable owner?
� ,2 ) 000 ❑ Yes El No
es
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is deferent than that of applicant.indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
-
Mobile Home QC 6-1.1-7)
Name of mortgagee or meted seller
CTFCct .
Address of mortgagee or contract seller(number and steel,city,state,and ZIP code)
E✓elegr6 SUSA/� K
Name of assignee or other owner Of holder of mortgage 9
(/
Add r of assignee(number and street,city,state,and ZIP code) /96`i
q
16c.
Does applicant own property in any other If yes,what county? • What Taxing District?
county in Indiana? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signs of County Auditor • County Date(month,day,year)
//cHZCt AA-A-
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.it,X Sig re(owner's full name) Date(month,day,year)Tiros_
Full resident address of applicant(number and street city,state,and ZIP cod')
�a-ro/ sQa4 /a 4 `or- Ha�Ssf���/ -,u v7635'
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of audfRfaed person (number and street,dry,state,and ZIP code)