HomeMy WebLinkAboutMortgage_Delong (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
Le:; FOR DEDUCTION FROM ASSESSED VALUATION I _-
• - State Form 43709(R71/6-09)
Pnsaibed by Department of Local Government Finance
INSTRUCTIONS:-
eM a t!
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought County
Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months LEG a!1 t
before March 31 of each year the deduction is sought r,043g Recorder
See reverse side for additional instructions and qualifications.
Applicant(• ..ran contras buyer-s-:restrictions onIs site) l
I 4- _ t/ GIBSON COON _ . a_
Taring District- - - _ t (/ /I Mol 3�yo a - Dot). lo g—0c26 Record number Page n• .-
Assessed value of real property as of ' D _Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness un
March 1,ament year March 1 at n[weer date of application paid as of le the applicant the sole
�IrC' m�> pp legal or equitable owner?
( 3iap ❑ Yes ID 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 Qitferent than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• I Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller I I ,
Address of mortgagee or contract seller(number a street,city,state.and ZIP cadet."/
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,slate,and ZIP code)
Does applicant own property in any other If yes,what county? , What Taring District? Has Nis deduction been requested on property
county in Indiana? for(Went year?
❑ Yes ❑ No 1 ❑ Yes ❑ No
COUNTY AUDITOR I
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of County Auditor • County I Date(month,day,year)
I l 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 I contract buyer of the aforementioned property on date application is filed.
• e -titre(owner's hdl name) I Date(month,day,year)
• w. •` ill -.N. . w aes.-
F Trent address of apps ant(number and street,sty,slate,- t• P code)
►o-1 v> kjiLtr„,r--, $r r-1--,(IN x-_, ,Q - u,tnUt I
authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry,state,and ZIP code)