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HomeMy WebLinkAboutMortgage_Hardiman t T; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year e FOR DEDUCTION FROM ASSESSED VALUATION '_ _t'l State Form 43709(R11 1 609) gn Prescribed by Department of Local Govemment Finance I n_ D INSTRUCTIONS: 11 q��mUU1II To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located.' F`p p�2 ' 20 Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought. I "`© County Pditor 2) Mobile/Manufactured Homes not assessed as Real Property Must file during the tweWe(12)months before March 31 of each year the deduction is sought I , CO My j,..... See reverse j. for additional instructions and qualifications. �"'y" I �er npprrcant(�er ovmntractbt -r - .. reverse side) GIB-SON COUNTY AUDITOR aL/YnQ�c T.:f , : `a'?V- 0 /-®00- �03Cis--00? g Record number Page number 3 Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/ ndebtedness unpaid as of Is the applicant the sole Mardi 1,amen year March 1,agent year date of appbcation _-`7 t legal or equitable owner? (2 ❑ Yes ❑ No If no,what is his I 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 a property in question:Annually Assessed Real Property ❑Annually Assessed I Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller ) /) a."--ed • Address of mortgagee or contract seller(number a street,city state,and ZIP aide) Name of assignee or other owner or holder of mortgage /, r� ,r/ 1 /�y/ Address of assignee(number and street-city,state,and ZIP code) �L!-/�/K/ `/�-#� / ,o I � Id Does applicant own property in any other If yes,what county? - What Taxing District? Has this aonbeen requested on property county in Indiana? ❑ Yes CI No for current year? ❑ Yes ❑ No I COUNTY AUDITOR I Deduction approved in the amount of --r—SuSf�. 9�a7�(3 20 20 20 20 1Y\� I Signature of County Auditor County -HARD Q S �N IC i mm- urVV.� a1GQSf _ I/We certify under the penalty of perjury that the above and foregoing information is o .$ ( �RN - 13-54 owner/contract buyer of the aforementioned property on date application is filed. •J 1 / �1Signawre(owner's fact name)/ //,/ Date(month,day,year) I` tYi r Q.dd es. 'L-Y ait(numberaLQ/1[� 'Fu0 resident address of applicant(number and street,city,state,and ZIP code) 0- 9 4e/RA/E 41-116 Pe,we&roN tr/ V7670 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-03 I Date(month,day,year) Address of audio(. person (number and street,city,state,and ZIP code) I -