HomeMy WebLinkAboutMortgage_Howes ex STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Colin Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
- State Form 43709(RI1/6-09)
Prescribed by Department of LOcaI Government Finance : R�:
Iwo ell- It
INSTRUCTIONS: I •
Form eed with:
To be filed in person or by mad 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 D i C 13 28L3ry Auditor
2)Mobile/Manufactured Homes not acc-aced as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications. fflre •r
Applicant(owner or contra?. r-see restriceors nee r ee)- o i � �, GIBSON COUNTY AUDITOR or
Taring District • number//legal d phi Record P
-ly _1 001 .f�l{ I -COO a o?I
Assessed value of real property as of Mortgage/ tract indebfSi ness unpaid as of Mortgage/Contract adebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,Wner t year data of application I legal or equitable owner?N
1_T l/.rl� ❑ Yes ❑ No
If o.what is his!her exact share of interest? I
n If owned with someone other than spouse!indicate with whom
If name on record is different than that of applicant,indicate below Is the piopemy in question:Annually Assessed
❑Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 9'3
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street dry,stay,end ZIP are) —
Does applicant own property in any other Has Nis deduction been requested on property
county in Indiana? ❑ Yes for current year? ❑ Yes ❑ No
Drawer IN /� yo./...3
y f, ...
1
Deduction approved in the amount of. •. 2l I Card \10. ! 6���/
20 20 (20 20
Signature of County Auditor I 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/contract buyer of the aforementioned property on date application is filed.
Signature en's fief ame Date(month,day,year)
/� 3 d dri- or t(n tuber and street GIN tea n code/ (� LI ��
/Person authrxrzedSby duly executed Power of Altomey or by IC 6.1.1-12-0.7 `\l)/•y_I Date(month,day,year)
Address of authorized person (number and street coy,state,and ZIP code)
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