HomeMy WebLinkAboutMortgage_Templeton a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION �Ip�'1 gA9
State Prescribed 43709 Department/6-09) 1L 1'.
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Prescribed by Department of Lod Government Finance
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INSTRUCTIONS:
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To be Ned in person or by mail with the County Auditor or County Recorder of the county where the property is located. } Nµ1 it 1 L u 13
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 Must file during the twelve(12)months
before March 31 of each year the deduction is sought - I ,j !" • -Boarder
See reverse side for additional instructions and qualifications. G I BSON COUNTY AUDITOR
Appecan (owner or contract buyer-see resrricaons on reverse side)
T District Key number agar description -Record number Page number
0140 - / a -a9- c-/oa -000 . 96,01 -oa, 7 ) 3 570 /
Assessed vaiue of real property of Mortgage/Contact indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,cumxnWait date of application legal or equitable owner?
�f opop I ❑ Yes El 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 ❑Mobile Annual N Assessed
Home(IC 1.1-T)
- I Name of mortgagee or contract seller 1r A ^W /1
Address of mortgagee or contract seder(number and street,city`-state.l/and ZIP code)
Name of assignee or other owner or holder of mortgage I
�_-1��L.-{l-�ry1�1
Add of assigneegumber and street.city,state,and ZIP code) `'J�/ t C'h - . f) - 1.�-
Fl E d9- OR -/0 / . 574- c p�/l ftClC
Does applicant own property in any other If yes,what county? • What Taxing ry _
manly inlMana? / ] _ 500) I
❑ Yes ❑ No J No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 __ I I <u
Signs of County Audio( County Date(month,day,year)
I I We certify under the penalty of of pe above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of t&a -6y ,mentioned property on date application is filed. I
1 _ (awne full 77)/ - Date(month,day,YEA
�
u0 resd address scant n . ' ] ,G y
-Person
by duty executed Power of Attorney or by IC 6-1.142--0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) I