HomeMy WebLinkAboutMortgage_Stone STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS TEE Vic. Year
FOR DEDUCTION FROM ASSESSED VALUATION
l 1=i State Form 43709(R11/609) •
Prescribed by Department of Local Government Finance -
INSTRUCTIONS: DEC 1?leg'
orm filed iwith:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located.
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought. I ,1.,J..unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)mont , ig271.
before March 31 of each year the deduction is sought. I (> rd
er
GIBBON CC UN A"
See reverse side for additional instructions and qualifications. I
Applicant(owner or con buyer-see restrictions on re�
T sold Me ben I I d pIke Record number P e number
- ate-Q.ao'4/7\ e I ed -3 0 y - f�D(?• 3S3 DaD / 3 91
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant t sole
March 1,current year March 1,current year date of.appb atn� legal or equitable owner?
( ( ❑ yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouses indicate with whom
If name on record is different than that of applicant.indicate below: Is the pioperty in question:Annually Assessed •
❑Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or:tinned seller ^ r, 4 In a r.
Address of mortgagee or contract seller(`//number and street city,ate,and ZIP code) - H
Marne of assignee or other owner or holder of mortgage
Address of assignee(number and street city.state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has thii deduction been requested on property
county in Indiana? for current year?
El yes No yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20_ 20 20
Signature of County Auditor ' County I Date(month,day,year)
I 1 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. I
Signature( rs crams) C' ` Date(month,day.year)
F en dress of applicant(number and street city,state,and ZIP code)
2o3 ,v. /Mla.. -St.
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)