HomeMy WebLinkAboutMortgage_Hanks r.p,„,i_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County- shi r
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(M1/6-09)
Prescribed by Department of Local Government Finance rt,-,�-��}r�
INSTRUCTIONS: P`' •1 N 2a13
Form Fo filed with:
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 Property:Must file during the year for which the deduction is sought. Co
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 GIBSON OUNT AUDITOR
See reverse side for additional instructions and qualifications.
Appfirant( buyer ,see CAA A t -tb ST)
Taxing ist um
rl Key number/legal description Record number Page number
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the app6ract the sole
Matt 1,crrera year Martin 1,current o �� date of applkatun legal oraeWrtable
1 ea
If no,what is his/her exact sham of interest? 1 If owned with someone other than spouse,indicate with whom 0 No
It name on record is different than that of applicant.,indicate belowc .,Isss the property in question:Annually Assessed
f Z}ae1dt Property r dally Assessed
-C / ie Home(IC 6-1.1-7)
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Name of mortgagee or contact seller
". - of nrrlgag-•\ con.`seller(n - and street city state.and ZIP code) /
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-
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Name of assignee or other owner or holder of mortgage
rON el
Address of assignee(number and street tidy,state,and ZIP code) ` r
•
Does applicant own property in any other If yes,what county? • % CC‘‘ ' , Has this deduction been requested on prmi try
county in Indiana? b arras year?
❑ Yes �]'No
❑ Yes p No
COUNTY AUDROR
Deduction approved in the amount at.
20 20 20 20 20 _ 20 20
Signature of County Auditor - County Date(month,day,year)
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 buyer of the aforementioned property on date application is filed.
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a Date(month,der.reap
rASdant address of tnu�rd sbeetP code)
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Person 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) .