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HomeMy WebLinkAboutMortgage_Westlund t,4 .., STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R11/6-09) Prescribed by Department of Local Government Finance L le a INSTRUCTIONS: 7o 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 Properly:Must fife during the year for which the deduction is sought I1 County Auditor cil 2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)mop i •2 9 I before March 31 of each year the deduction is sought. - County Recorder See reverse side for additional instructions and qualifications. , - i Appit^ (o.wner or buyer-t ructions re I� 'ter.i7 rr 4-17T lh VW� — @i - //04.99---. GIBSON COUNTY AUDITOR Taxing Disrict _.l' v I legal desolation -01(28 l3 P 13I Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole March 1,anent year March 1,orpnt years� date of application T I legal or equitable O (OG eq Yes If no,what is his/her exact share of interest? I If owned with someone no,--" poose,i Indicate with whom If name on record is different than that of applicant,utduati - u �/ the*petty in question:Annually Assessed Q(, )(16,56°..© I /-1 ,Real Property ❑Annually Assessed `H' `-hl I Mobile Hone QC S-1.1-7) Nameof T.:.>- .., seller ...-.. �� Dl1\\'Cl' \0. I Address of mortgagee or contract seller(number and street r 1 17.. .1........... Name of assignee or other owner or holder of mortgage Card N O. Address of assignee(number and street,city,state,and ZIP code) Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property county in Indiana? ❑ No for anent year? ❑ Yes ❑ Yes ❑ No I COUNTY AUDITOR I Deduction approved in the amount of: 20 20 20 20 20 20 20 Signature of County Auditor - County I Date(month,day,year) I 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. Signature(own hit name) aid I Date(month,day,year) Sit. V resident address of applicant(number and street city,state,and ZIP code) iSla Lirhn wood Dr, Pilo,,do. 2N 99&70 i - -- -- authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 'f Date(month,day,year) II Address of authorized person (number and street city,state,and ZIP code) I