HomeMy WebLinkAboutMortgage_Fritz (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township bear
FOR DEDUCTION FROM ASSESSED VALUATION g
1: State Form 43709(R11/6-09) 9]
Prescribed by Department of local Government Finance
to an
INSTRUCTIONS: E�,,s, Ai q
To be filed in person or by mad with the CountyAuditor or County Recorder of the county where the property is located. €il i Z 0 13
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months /)i o er
before March 31 of each year the deduction is sought - Ndtf
See reverse side for additional instructions and qualifications. �f�\ GIBSON COUNTY AUDITOR
Applicant(owner or contact r-see restrictions on ev )� 3\7l XY
n9 District Key number/legal description Record number Page number
sl s-0 ', aCa - ta - C I n9 -ba3- 1"1 -f) t3 t,-1bl
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mort age/Contact ind unpaid as of Is the appli ant the sole
March 1,=rent year March I.current year date of application legal or equitable owner?
0Thpor - - fes ❑ No
If no,what is Ns I her exact share of interest?
1
I \
If name cc record is different than that of applicant,indicate below.. ',Assessed
Assessed
tonne(IC 61.1-7)
Na -of wee or contract seller l-
Address of mortgagee Of contract seller(number and street,city,state,and ZIP...,
Name of assignee or other owner or holder of mortgage LWV E 12s c E. 0 DIE Ofkirs
Address of assignee(number and street,city,slate,and ZIP code) J, /\C inc IL L taJ_N
Does applicant own property in any other If yes,what county? • I 3 - (o'7 05 1 ..property
county in Indiana?
❑ Yes No 'es ❑ No
THOMSON R
COU :: Wit:-.1 EUTERS'
Deduction approved in mou
the ant of ::::;•
20_ 20 20 20 20_ 20 20
Signature of County Auditor 4 County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Signature o to name) Date(moth,day,year)
��_A I P 7•
pF�residers address of apparent(number a t chJ!state,and LP code)
(" 136, E. 62o40w/14 S —
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,city,slate,and ZIP code) .