HomeMy WebLinkAboutMortgage_Nelson (6) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County :ownonip Year
4
Y FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R11/
Prescribed by Department thcal Government Finance .�
� e 101"a
INSTRUCTIONS: ed
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.DE C N I ta,,17 NL tl I,'
Filing Dates: 1) Real Property. Must file during the year for which the deduction is sought. I ❑ County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must Re during the twelve(12)months
before March 31 of each year the deduction is sought I//, • ieuntYRecorder
)dgQ�L�t/17�
See reverse side for additional instructions and qualifications. G IBSO N COUNTY AUDITOR
Appfranl( Cr contract buyer-see restrictions
i-
T O Key number/legal desaipto co number n Record numb Page number
aC0J-0 p a4-ii-IV- 200 _ 00 (-1 a (9, o a ) /-3 ?-/ A7
Assessed vat*of real property of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
Mandl 1,current year March 1,current v date of application legal or equitable owner?
/ cT `1/ i00 1 ❑ yes 0 N
If no,what is his I her exact share of interest? ft owned with someone other than spouse,indicate with whom
I
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller /J
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,city,slate,and ZIP code) Al ELSO 1 l 1/)\r�rye
Pr NF 14- -II (-1 , o � C Si) r) rrT�JJI/LXf,
Does applicant win property in any other If yes,what county? • What Taxing Dis
cointy in Indiana?
❑ Yes ❑ No
COUNTY AUDITOR _
Deduction approved in the amount of
L
20 20 20 20 20 120 20 _
Signature itot - County I Date(month,day,year)
/Cit-e 1.91 ,
I I We certify under
the penalty of perjury that the above and foregoing information is true and correct and that theiapplicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
0 Signature(OiCC . n27 I Date(maw,day,year)
Full resident address saappli applicant(number and street oily,state,and ZIP code)
Sts- S. ern nor A Or. I?rinot 1,, rA/. 97670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street arty state,and ZIP code)