HomeMy WebLinkAboutMortgage_Strange .r.-„,„:„. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Only township Year
;. FOR DEDUCTION FROM ASSESSED VALUATIO IT E
I: State Form 03709(R11/6-09)
Presmbed by Department of Local Government Finance
File Mark
INS7RUCTIONS: 2Q\3
To be filed in person or b mail with the County Auditor or County Recorder of the county wh O(��f Form Nom '
Y N N ry ereTrle property is located
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought.
2) Mobile/Manufactured Homes not assessed as Real Property Must file dunn e hire onths County Auditor
before March 31 of each year the deduction is sought • I County Recorder
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITIOR
t-CJ"-�+'4 b -see restricSOns an reverse side)
I
T ' District Key number/legal desorption o/ - Record number Page number
�� alt-i -ilo-' e10 - ova /7/ Da-7 aoi 3 5Li6 h
Assessed value of real property Mortgage/Contract indebtedness unpaid as Mortgage/Contract Indebtedness unpaid as of Is the apparent the sole
March 1,aortae year March 1, / t date of application legal or equitable owner?
r p 600 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 property in question:Annually Assessed
❑Real Property ❑Annually Assessed
I Mobile Hone(IC 6-1.1-7)
Name of mortgagee or contract seller
I
Address of mortgagee or contract seller(number a t city,.state,and ZIP code) -----(/�/ /"2J
Name of assignee or other owner or holder of mortgage /71 O l t s-....
Drawer �u.f/
Address of assignee(number and street my state,and ZIP code)
o.t.a......
Does applicant own property in any other If yes,what county? • What Toxin Card N0' ...--• rty
county in dam?
❑ yes • N. I No
ImJ�i. .tiff
COUNTY AUDITOR
Deduction approved In the amount oft
20 20 20 20 20 20 20
Signature of Canty Auditor County Date(month,day.year)
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
owner/contract buyer of the aforementioned property on date application is filed.
?nature(own I Date(month,day,Year)
Full resident address of applicant(num street city,state,and ZIP code)
- /2s1 5. LooXoUt /117^1. I,e, PK/licem 1 7G
on� i 470I
Person outwitted by duly executed Power of Attorney or by IC 6. r
1.1-12-0.7 1 g / r I Date(month,day,year)
Address of authorized person (number and street S:state,and ZIP code)