HomeMy WebLinkAboutMortgage_Schu s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
i�-��s FOR DEDUCTION FROM ASSESSED VALUATION
�- State Form 43709(R71/6-69)
Prescribed by Department of Local Government Finance
FId LED
INSTRUCTIONS:
To be filed in person or by mail with the County F Auditor or County Recorder of the county where the property is located.DEC Y
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought N 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 - -/// °h`�e�rder
See reverse side for additional instructions and qualifications. GIBBON CQl1NTY o
Apo6ca t rroor=Mast onreverse side AUDITOR don
T 'C / _a-o o C/d�Vdr Ge-
Record
20 3 Pagan o s
value cf real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,covert year March 1,anent year date7nonwo legal or equitable owner?
Dyes ❑ 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 appt indicate below Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-T)
Name of mortgagee or contract serer)rx ' 4' ^ 2(/ n
Address of mortgagee or contract seller(number and street,/`cibt state,and ZIP code) /I/ 29 /7
Name of assignee or other owner or holder of mortgage _ — (/rr./ -�'/l Y/C'Y
-5c LucAs 7 d� 1- /a
Address of assignee(number and street city,state,and ZIP code) r�I / 7°���
—36)-ii")
Does applicant own property in any other If yes,what court dion been requested on property .
county in Indiana? ❑ Yes ❑ No an ❑ Yes
/3 - /// 05 ❑ No
Deduction approved In the amount of:
20 20 20 20 20 20 20
Signature of County Auditor • County Date(month,day,year)
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 I contract buyer of the aforementioned property an date application is filed.,
1' Signature(owners i>, ) Date(month,day.year)
- resident of applicant(number and street ally,state,and ZIP code)
k- 77y s aoo 6 Ff.h''.,c4, , L .-- V76v? .
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day:year)
Address of authorized person (number and street city,state,and ZIP code) .