HomeMy WebLinkAboutMortgage_Duguid . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
' FOR DEDUCTION FROM ASSESSED VALUATION ��
I! State Form 43709(R71/609)
Prescribed by Department of Local Government Finance
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form filed with:
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. OCT 1 7 3 County Auditor
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 - ❑ County Recorder
See reverse side for additional instructions and qualifications. 4 -�' (b f
scant(owner or contact uyer-see re. was on reverse side) G���j�f'��'� GIBSON'COUNTY AUDITOR
T " istruY Key number/ ption ^/ '/ Q jJ numbs Page number
a2lo- /! /d, - /03- ooa2. i�/7 - o ) 3 o t 3 a/o(
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sale
March 1,anent year March 1,current year 7� date of application I legal or equitable owner?
IOD) 00D ❑ Yes ❑ No
If no,what is his/her exact share of interest? tf 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
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller a? _• _ D- - ' 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 y - -—
Andress of a1 ce(number and street, nd /q0 /J� ( -
V0-44/1'e-4 At Di-awer NO.Does applicant own property in any other If yes,what county? • What Taring District? �//1 ,(� -
munty in Indiana? ❑ Yes ❑ No •.-.(9// 1/
Card NO. �`.. tY. \
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Sigra of County ad/6% / - 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
er I contract buyer•f the aforementioned property on date application is filed.
X (o(avmare/rs na / Date(month,day,year)
�3ddress-ys_ . / a,
resesae W`n• t(nu rand street d7 state,a 'P code) •
4 400a (,(_Y erumli0id R-✓e i nkeho Trci 1476,7o
Person authorized by duty executed Power of Attorney or by td 61.1-12-0.7 '
so Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)