HomeMy WebLinkAboutMortgage_Miller (29) 2!45 . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
7 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Lod Government Finance
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Fit a
INSTRUCTIONS: a t�pr�e::
lb 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 Property:Must file during the year for which the deduction is sought ., Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)month C T 0 i 1
before March 31 of each year the deduction is sought - my Recorder
See reverse side for additional instructions and qualifications. - -
f
Ap t(owner or contract buyer-see restrictions on reverse side)
�K, � j[Qp� GIBSON COUNTY AUDITOR
istrvt Key number legate l description Record number Page number
o fa& ' 1t -J( - ?DO - 000, 0to7 - 0 ). 7 X013 44IJ-
Assessed value of real propety of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current)ear March 1,anent year date of application legal or equitable owneR
1 a ono ❑ yes 0 N
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 ddferent than that of apprrant,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
•
Address of mortgagee or contract seller(number and steel,city:state,and ZIP code)
Name of assignee or other owner or holder of mortgage /_/��/ / �"7�
Address of assign number and street,city:state,and ZIP code) Drawer NO C- ° ( ✓
PT t NE Ilo , a - / I I7 . (os' 87 Ac..-
Does applicant own property in any other If yes,what county? • What Taxing District? '
county in Indiana? ❑ Yes ❑ No Card NO.
COUNTY AUDITOR
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of�uan
Cottyy Auditor County Date(month,day,year)
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/contract buyer of the aforementioned property on date application is filed.
vSignature(owners Nil as Date(month,day,year)
msid address of appFir nt(number and street.city,state,and ZIP code)
ent /
9a, S 36-o u) N-<<-cet`a„ L'1
l iN (010
Person authorized by duty 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 state,and ZIP code) .