HomeMy WebLinkAboutMortgage_Delong }}.: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Courity Township Year
,,- FOR DEDUCTION FROM ASSESSED VA 1F"rISI ED
,`s. t'. State Form 43709(R1116-09)Pr escribed by DepatUnent of Loud Government Finance r
File Mark
INSTRUCTIONS: ICI(�V 1 211 3 Form bled wide
To be filed in person or by mail with the County Auditor or County Recorder of thl`c6unty ere a property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. I County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property rile du • (12)months
before March 31 of each year the deduction is sought � County Recorder
See rev
shie for additional instructfrjr.s and qualifications. GIBSON COUNTY AUDITOR
or contract b + a side)
Kest l l I d aiptiob Record num Page number
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value of real property as of Matgag'. indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 7.,,- � •p data of appacuann I legal ❑ O owner?
IV^J Yes
If no,what is his/her exact share of interest? I If owned with someone other than spouse,Indicate with whom
If name on record is different than that of appbonl indicate below. Is the property in question:Annually Assessed
❑Rea)Property ❑Annually Assessed
• I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract sefer(number and street ZIP code)'
Name of assignee or odor owner or holder I
Address of assignee(number awl" ')
/ Does ar-:_ _t)� 55 {L •county? - What Taxing District? athiindeduuction been requested on property❑ No
U
➢� I�' I ID yes
COUNTY AUDITOR
20 20 20 20 20
i ,
Skim —AN Auditor • County 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 I contract buyer of the aforementioned property on date application is filed.
re ) O/') � L— Date(math,day,yeah
/ C/f o
resident address of applicant(number and street,oily state,and ZIP code)
1 ? bv roods [f a. t/b514,1 f- Z4 t(')( 7
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month.day,Year)
Address of authorized person (number and street.sty,state,and ZIP code)