HomeMy WebLinkAboutMortgage_Ottman is .: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;`ice; FOR DEDUCTION FROM ASSESSED VALUATION
State Form d 43709(rtm/Department of l
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Prescribed by Oepartmern of local Government France
INSTRUCTIONS: Form flied with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is
IVU V 1
Fling Dates: 1) Real Property Must file during the year for which the deduction is sought. U V 24 County Auditor
2) Mobile/Manufactured Homes not assmssed as Real Properly Must file during the twelve(12)months) • ry Recorder
before March 31 of each year the deduction is sought
I f I I it
See reverse side for additional instructions and qualifications. ��"'��'
Appfscanitiowner or contract buyer-see restrictions on reverse side) GIBSON COUNTY AUDITOR
Taxing District Key number/legal description Record number Page number
tin/ ote,..dr ? Go ' )? - 3to - y03 -00o. o , 7 -009 , 0.0 / 3 43
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Assessed vale of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applcant the sole
Mach 1,anent year March 1,current year data of application legal or �e
Iasoo (� D No
If no,what is his/her exact share of interest? r If owned with someone other than spouse,indicate WM whom
I
If name on record is different than that of applicant,indicate below Is tie property in question:Annually Assessed
R4eal Property'❑ArmuallyAssessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller ,p 7_r c
Address of mortgagee or contract seller(number and street city,state,and ZIP code) _
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sbeet,nay,state,and VP code) Drawer- NO... ( ,3...
• mot hGT-S �No C1,c *,� /o/ J�
Does applicant own property in any other If yes,what county? What Tax /5 r 5 Y
county in Indiana? 0 Yes ❑ No Card NO I ✓ t J No
COUNTY AUDITO..
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature'ooff County Auditor,
' County I Date(month,day.year)
na
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
I contract
,m of the aforementioned property on date application is filed.
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` (owe r,/ I Date(month,day,rear)
/X` ull resident of t(number and street rsy,state,�a�+ P )
Id) 3 onn.1 LAI rig 97639 I
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street dry.state,and ZIP code) I
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