HomeMy WebLinkAboutMortgage_Curl a. STATEMENT OF MORTGAGE OR CONTRACT IND i m y 1 Township Year
FOR DEDUCTION FROM ASSESSED VALUATIONE�
'--P'' l�- State Form 43709(R11/609) i
Prescribed by Department of Local Government Finance
File Mark
INSTRUC71ONS: NOV 0 82013
Ft be filed in person or mail with the Court Auditor or County Recorder of the county where the m Farm filed with:
Pe by ry ry ry 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 Properly Must file dun- month's
before March 3/of each year the deduction is sought ❑ County Recorder
GIBSO7IN33vCOwUNTY AUDITOR
See reverse side for additional instructions and qualifications. I
Appfrant Avner or contact buyer-see restrictions on re side) '
/lam n OStit, C.Z&Z I
Ta;rig D' i• Key number/legal desaipaon Record number Page number
lallf ..._J - - a _4 � 4 _ a . 0 3 iv
Mortgage/Contract indebtedness unpaid as of Mortgage Contact bWebtednesa unpaid as of Is the applicant the sale
Marts 1,current year Maras 1,cement year date of application legal or equitable owner?
JO I ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,Indicate with whom
If name on record is different than that of applicant indicate below: Is the
,;,r�property in question:Annually Assessed
Ld9veal Property ❑AnnualyAssessed
T I Mobie Horne(IC 6-I.1-7)
•
Name of mortgagee or contract seller)?seller Address of mortgagee or contract seller(n and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
-_
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Twin i O •TT''• uty
county in Indiana?
0 Yes ❑ No O I No
I COUNTY AUDITOR 1......1•-• •
Deduction approved in the amount af: Car \O• .
20 20 20 20 l 20 1 20
Signature of County Auditor • County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and cored and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.cif raze(owners At name)_ Date(month,day,year)
\/Fuull resident address of applicant(number pcncity,state,and ZIP e
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(m in.day;,year)
Address of authorized person (number and street city,stare,end ZIP code)