HomeMy WebLinkAboutMortgage_Andis (2) �,: .. STATEMENT OF MORTGAGE OR CONTRAC D S County Township Year
"i..I FOR DEDUCTION FROM ASSESSED VALUA b�
lx'-w�:Jf Stan Form 43709(R11/6-09)
„iii Prescribed by Department of Local Government Finance
INSTRUCTIONS:
OCT 1 0 2013 File Mark
Farm filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the cou where the pro erty is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is ht. • - unry Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Mus (12)months
before March 31 of each year the deduction is sought. GIBSON,COUNTYAUDITOR ❑ County Recorder
See reverse side for ad 1 al instructions and qua .tions.
id r
Apprranuora nor.. r-s restrirbuns ) I
Taxing•- num legal d ' lion Recall Page number
' - - - (-/ -do- 00 1-Oo( 1 (5 o/
Assessed value of real property as of Mortgage tract. e ness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant me sole
March 1,ctsret year Marti 1 Q T ht 0/�(0�\ date of aPPace legal a equitable wmer7
o0r0 ❑ Yes ❑ No
If re,what's his/her exact share of interest?
7 if owned with someone other than sparse,indicate with wham
If name on record is different than that of appbcanl,indicate below.: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
/� /) /�1� l /��JJJ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller / )/)/ )i/L L
Address of mortgagee or contract seller(number and street Lstree/ 4 city l`state,and ZIP e)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,end ZIP code)
what county? • What Tardrg District? Has this deduction been requested on property
for wrlent year? El Yes El No
D1":11YC1" NO c9-40)-..5
(/�/-'/-��( COUNTY AUDROR
Card NO. L9.O \..
20 20 20 20
Signature of Auditor • /e County Date(month.day,year)
I e 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 of the aforem p - ned property on date application is filed.
SlOna /cyQrreme) ^L �` Date(month,day,Year)
Full resrdenl �ofl.,a.p fir/`-t(nu r and sheet te,and ZIP )
�o 19 LA Kr t>.J 0 e1`r aftc r'.cco /At '17(X9
Person authorized by duly executed Power of Attorney or by IC 6.1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,stare,and ZIP code) -