HomeMy WebLinkAboutMortgage_Whisenant f STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
-sT.��; State Form 43709(R11 16-09) g J Fi
Prescribed by Department of Lod Government Rnance
INSTRUCTIONS: F1 'le k
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Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. r 2'fa
Filing Dates: ) Mobile/Manufacttured Homes not assessed as Real Property Must sought during the twelve(12)months OCT 2 my Audtor
before March 31 of each year the deduction is sought - /1 ❑ County Recorder
See reverse side for additional instructions and qualifications. J 1���
r e v e r s e Applicant(owner GIBSON COUNTY AUDITOR
T Districts Key nnumber/I description J Record Pa
d number Page number
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1.once year March 1,current ar date of application legal or equitable owner?
Cr.' C70 (] ❑ Yes ❑ No•
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 afferent 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 -1142-1
Address of mortgagee or contract 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, code) 4
Dees applicant/lli/C/.6ownCn property eperty in any other If yes, /whaattt county? - What Taxing District? Has this deduction been requested on property
county in Indiana? El Yes 171 No for cement year? ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of —
20 20 20 20 2
Signature of County Auditor• • County /Q C-57
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I I We certify under the penalty of perjury that the above and foregoing information is true a
owner I contract buyer of the . .,- entdlled property on date application is fled.
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resident address of... t(number and stnst,at:state,and ZIP de)
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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,state,and ZIP code) .
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