HomeMy WebLinkAboutMortgage_Hume (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
m ;; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 /
Presabed by Department of lo
cal Government Finance Ell
FIe ark
INSTRUCTIONS: ,�,,p
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Forrr wn3 0 2013
Filing Dates: f) 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 Imo, q
before March 31 of each year the deduction is sought - X-K-.CO a er
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Appbrant n. or/ ,buyer see m sid
glir Al V1/4 ap
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract' ess unpaid as of Is the applicant the sole
March 1,wren year March 1,current year date of application �f legal or equitable owner?
, ❑ Yes El No
If no,what is his I her exact share of interest? If wined 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
Real Property ❑Annually Assessed
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Mobile Home(IC 6-1.1-7)
Name of coo(' ee or contract seller // �/1. 2/7 �y n qt WvL 4 Q' Q�_ /"^�
Address of mortgagee or contract seller(number and street city.state,and ZIP code) 0
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,vete,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? fur current yeah
❑ Yes ❑ No ❑ Yes ❑ No
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Dedumon approved In the amount of.
are reOL ; P4-1 The--
20 20 20 / ny1` ) 20
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Signature of Canty Auditor •year)
I I We certify under the penalty of perjury that the above and foregoii dent of Indiana and
owner/contract buyer of the aforementioned property on date appl'a
i. Sig t�u!rre,\)( wire Ml name)N ���,(`-�� I Date(rrwndr,day,year)
XFW i en�oflaptp nt(number d street city,state,and ZIP code)
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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,tlry,state,and ZIP code) .