HomeMy WebLinkAboutMortgage_Kingsbury STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Courp I T ear
af'
FOR DEDUCTION FROM ASSESSED VALUATION
State Fonn 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: I I 1 I
. N-. p^.
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. I .u
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months -want,-want, Recorder
before March 31 of each year the deduction is sought I. sw
GIBSO• • • • . =
See reverse side for additional instructions and qualifications. I
Applica /I./` /./ isee_/ reverse e) C /
iso- her I legal d a Record number Pag number
04gQ 6-6-/07- .S a0-03-t(3-mot /°o - o06 07G i3 Joan
Assessed value real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract'indebtedness unpaid as of Is the applicant the sole
March 1,arrant year March 1,cement year date of appfratmn legal or equitable Amer?
�(JjrQ_)% /250 ❑ Yes ❑ No
If no.what Is his/her exact share of interest? I If owned with someone order than spouse,indicate with whom
If name on record is different than that of applicant indicate bebvr I``Is tt ee property in question:Annually Assessed
/ O I 77v e Property ❑Annually
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seler(number and street,aN,state,and LP e) I n/ /y
Name of assignee or other owner or holder of mortgage C/.kT_.I j
Address of assignee(number and street,city,stale,and ZIP code) I /Do?/ ,/U
Does applicant own property in any other If yes,what county? Waal Taxing District? Has tho deduction been requested on property
county in Indiana? ❑ No for current year?
❑ Yes ❑ Yes ❑ No
I
— — _ .rnuMTV..AUDITOR
Deducda __ _I
20, I � 5 C) �20 20
Signatun Date(month,day,year)
W l
I/ applicant is a resident of Indiana and
ovine �` I I 1 ��� oml� i
t. Signatun on(month,day,year)
Fu nisi(
Aeron 7_,0 _ l J i Date(month,day,year)
Add ass
i
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