HomeMy WebLinkAboutMortgage_Goedde r.�# % STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION T gy , x
LI
State Form 43709(RU/609) ll tl 9R
Presmbed by Department of Local Government Finance ��f
File Mark
INS7RUC77ONS: '/� 1 ,,p,M
To be fled in person or by mail with the County Auditor or County Recorder of the county where the property is loco .N 1 V-�' + -
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought ❑ County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must Re during the twelve(12)"°
before March 31 of each year the deduction is sought - County Recorder
See reverse side for additional instructions and qualifications. G I B SO N COUNTY AUDITOR
ADD&'ant or contract buyer- s4p`,
Taxdng DistrsY • V/ Key / description Record number Page number
- iii ia - aoY - oov. 59�f-oat AaL3 3744
Assessed vale of real property as of g Contract ind ness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the apptvant the sole
Mardi 1,asrent year A1amh 1. date of apps anion legal or equitdde owner?
b 0 D ❑ Yes 0 N
If no,what is his/her exact share of interest? r If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of applicant,Indicate below Is the
property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee(avast seller ^ /
N'/
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ,,^
LC2I. fireZ 2
Address of assignee(number a L dry.state.end ZIP code) '
69-PA %An - 57 PT Dra)i'er )\to.......t: ..:..;..
Does applicant own property in any other If yes,what county? , What Taxing District? •
county in Indiana? ❑ Yes
❑ No c N°. ...3%y
oc,COUNTY AUDITOR - rT ""-
Deduction approved in the amount ot. —
20_ 20_ 20 20 _ 20 20 20
'Signature - County
-C imr / L County Date(rtmm,day,fear)
I I We certify, u`nddeerJthe peenaatty of perjrjuuury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
�9 (ownA hie name) }nL� Date(month,day,year)
. ent address of IJmberand street city state,and ZIP code)
Sea, 5 /0or 4 51- , & e.�-r IIP I N; �7 •S
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,fear)
Address of authorized person (number and street city state,end ZIP code) .