HomeMy WebLinkAboutMortgage_Hyneman (2) .r
F . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _ County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
e Slate Form 43709(R11/6-09)
I
Prescribed by Department of Local Government Finance
INSTRUCTIONS: 4 �
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.• �9��-9991111 f2
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought County uditor
2)Mobile/Manufactured Homes not a«ssed as Real Property:Must file during the twelve(12)months ty
before March 31 of each year the deduction is sought - I C C T®2 c$9d$Recorder
See reverse side for additional instructions and qualifications.
—
Ap nt(owner or conaadb41'-se e %. on= y
GIBSON rnUtiTY AUDITOR
T District Key number/legal description Record number Page number
aJ 4-r>—'d ae:7 " Ctrl—as -/03 - o co. / 78 - bd- 0 /v' s/ al
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
Marts 1,anent year March 1,artrent year date of application legal or equitable owner?
Co51 oo O ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone odor than spouse,indicate with whom
If name on record is ddferent than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑AMobile 1-7)
Name of mortgagee or contract setter
Address of mortgagee or contract seller(number and s et,city,state,and ZIP code)
I
Name of assignee or other owner or holder of mortgage i— _
Address ee(number and street city,state,and ZIP code) -1
NT /f (4-) d5 - /-// 8 pC_ i vv ^
Does applicant own pnpe Taxing rty in any other If yes,what county? , What Tang District? U ,AJ4
county in Indiana? ❑ Yes
❑ No 7
COUNTY AUDITOR /3 /OC-/
Deduction approved in the amount of:
—
20 20 20 20 20 20 20
Signet County Date(month,day.year)
I I We certify under the penalty of perjury that the above bove 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.
Signs (owner's full name) Date(month,day,year)
_,i/, 4 ncn n_
1315 .S Alban Ad street 4401 de) y76h'o
Person authorized by duty executed Power of Attorney for by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city state,and ZIP code) _