HomeMy WebLinkAboutMortgage_Holcomb lfa:,r_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Loral Government Finance
File Mark
INSTRUCTIONS: a,L a �
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. i 1"ew t:2013
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. I 0 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. .der
GIBSI N
See reverse side for additional instructions and qu�ali/fidalions. /\///1 //p ,/���( r1�/ COUNTYAUnITOR
Ap t r orcgontracl buyer- or Ise side) 0 F/ aJbr-r l_ 6.,
T G J 7 (�-CL29..Si� 90?Y 1 (96i Pe35$
Assessed rake of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,current year date of appG�jigi legal or equitable owner?I ❑ Yes ❑ No Ofin
If no,what is his I her exact share of interest? If owned with someone other than spouse;indicate with whom
If name on record is different than that of applicant,indicate below Is' ,property in question:Annually Assessed
/ FS Real Property ❑Annoy
/ I Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller Assessed
Address of u.arlagee or contract seller(numbetrilaC27440
te,and ZIP code)
Name of assignee or other owner or holder of mortgage
t. Z)117/00/0 011I/07177
Address of assignee(number and sheet,city,state,and ZIP code)
I
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for Ient y 0 Yes
❑ No
•_— I
• JOUNTY AUDITOR
DraIYCr NO
2( 20 20 20 20
signr. Card ,r O• (43 5 5 County I Date(month,riot.leer)
.iS71)935: °I
I 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 bu -r of the aforementioned perry on date application is filed. I
. .-(owner's hill : e) , / Date(north,day,year)
•� •ent address of...•Grant(num r and t city,state,and ZIP code)
—730 ate fln-`� S Pri nCt f � 1!3 t 177 0
Perron authorized by d executed Power of Attorney or by IC 61.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) I