HomeMy WebLinkAboutMortgage_Colclasure e �'g STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year •
;t__ = FOR DEDUCTION FROM ASSESSED VALUATION
.: is State Form 43709(R11/6-09) I -
's„1 Prescribed by Department of Local Government Finance •
File Mark
INSTRUCTIONS: �7 Q QQ Zd2 —00 3 �
��,r-4 26 -20 -02— `f0 I—
To be filed in person or by mail 'r o ,j with: !
Filing Dates: 1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought. I� .'
Must be filed with the County Auditor or County Recorder of the county where the property is located = " '
on or before January 5 of the immediately succeeding calendar year. I C. n Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the, , II r 1
county where the property is located during the twelve(12)months before March 31 of each year the -
deduction is sought.
See reverse side for additional instructions and qualifications. I ' i—•i
Applicant(owner orcont U buyer-see restriction/�9qn reverse side) I W"t%" —4 -el
Pt etc 'K . CeiC/4 5u r f GIBSON COUNTY AUDITOR
Taxing Distrct Key number/legal description If r upll�e 1gerp1n 5 Ir
Acmcvd value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness'unpaid as l/of lis the applicaannt the sole
March 1,current year Marc�h^1.current year date of application legal or equitable owner?
b 2 1 cis-9 . 00 , (Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant,indicate below s the p perty in question:Annually Ascecsed
eal Property ❑Annually Assessed
eeeqqq I Mobile Home(IC 6-1.1-7)
Name of modgag or contract seller
Address of 1morty eee or contact seller(number and street,city,state,and ZIP code)
3 C 223 W. thus(, St. (ja Ela ✓� � C; + y N 417C z
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,sate,and ZIP code)
Does applicant own property in any other If yes,what county? 1 What Taxing District? Has this'deduction been requested on property
county in Indiana? for current year?
❑ Yes No I ❑ Yes -41.-No
I
COUNTY AUDITOR -
Deduction approved in the amount of: -
20_ 20 20 20 1 20 X20 20
Signature of County 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.
,Signatu - owner's:u0iiame,v 2 Date(month, �a��
/X\ / ` �`1yY/
Full resident.4. of applicant(number and street,city,state,and ZIP code) 1 _ I
51 3WO S. LJac tc or S-F-. act kola Ci4y 11/i • Lt7C (cO
Person authorized by duly executed Power of omey or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)