HomeMy WebLinkAboutMortgage_Carney b STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count)' Township Year
FOR DEDUCTION FROM ASSESSED VALUA J F,
.. 1,
' State Form 43709(R11/6-09) AAAAAA
Prescribed by Department of Local Govermnent Finance
File Mark
INSTRUCTIONS: z 79(n� Form tiled with:To be filed in person or by mail with the County Auditor or County Recorder of the county°wYerJ me pru is located. �-7('
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought 0d County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file tiring th by oaths
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions a qualifications. GIBSON COUNTY AUDITOR
Applicant(owner« I�sbcligns verse side)
rl \/ vW) li r l�jl.11�.Q.� �Q�(_J�n � �t/y'T�g�r L��q��)bery/w
7ayg Dy Y / /y/n/lath KeY number legal gesvipbon —'- . , �O(/ V`^-� I Record
I `r P� 1 ' V Y'
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Assessed value^eof real property y as of Abngaagggee(/Contract indebtedness unpaid as of Mortgage I Conte indebtedness unpaid as of Is the app t the sole
March 1.extent year Marti i year CYO date of appli anon I legal aO iade O
00�'l.•J( Yes No
If no, is his/her exact share of interest? / If owned with someone other than spouse,Indicate with whom
. ,what I
If name on record is efferent than that of applicant indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sager ' 1 d . / a
Address of mortgagee or contract seller(number and street city.state,and ZIP c`cod`e))
Name of assignee or other owner or holder of mortgage
— Address ,t�nu1mk � r� fa) I
en /�1 dl I L tat county? . What Taring District? ndeducion been requested cn property
All�'�A"_ ' 140 I ❑ Yes ❑ No •
i3-4°{nom I
" COUNTY AUDITOR I
I
20 20 I20 20
Sig Au I it« County I Date N daxx r) ,^
/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
• contract buyer of the aforementioned property on date application is filed.
-'ft•: -tun name) I Date(month,day,year)
s
till resident ad. of applicant(number and street.of4 state,and ZIP
Io33- � . .) b� .
Person uthot�d by duly executed Power of Attorney«by IC 6-1.1-12-0.7 I Date(month,day,)ear)
ibY Qr vi. 4AQ \ (1 /J 'n f' -
Address of authorized person (number a«lkaeet city,state,and ZIP code)