HomeMy WebLinkAboutMortgage_Wilhite (3) p.,,�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Courtly Township Year
6'1'7,4::` FOR DEDUCTION FROM ASSESSED VALUATION
-1' ' - State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: 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.
Filing Dates: I) Real Property:Must fife during the year for which the deduction is sought. 9 County Auditor
2) Mottle/Manufactured Homes not assessed as Real Property Must file during the twelve(12) „ r� a
before March 31 of each year the deduction is sought. $pg.,I�Jr ,.J�,Lo,,r, Recorder
See reverse side for additional instructions and qualifications
Ap t(owner or con buyer-see on reverse side)
[� U�4 � � oCT 3
Taxing District number/legal d Record number numbmb er r
Page number
1b-1a o1-304 -OW-Sy, -nag toys
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contact utdebtedn— t !y •t-.«' f77' -applicant the sole
March 1,current year Mardi t Mob date of application GIBSON COUN p- ` ,'.�-jb
L� l • Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate widt whom
If name on record is different than that of applicant.indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annualy Assessed
. I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller _--
Address of mortgagee or contract seller(number and sweet,city,sta nil ZIP code) 1 L u S 1-
Name of assignee or other owner or holder of mortgage ,j,.,,sIDA4
Address of assignee(number and street,city,state,and ZIP code) (J r 3 3 ocD J
Does applicant own property in any other If yes,what county? - What Taxing District? _ -.�ma m property
county in Indana? ❑ Yes -r
❑ No ) I a. ❑ Yes ❑ No
I
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 120 20
Signature of County Auditor County I 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 wired buyer of the aforementioned property on date application is filed.
rai r(o :/s full me) I Date(month,day,year)
.l. &.+� a�20i
Fu nt address d t(number and street,city,state,and ZIP code)
� Il E t ci- �;nc� �f7(o7o
, on authorized by duly executed Pawer ofAtt rney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street city,state.and ZIP code)