HomeMy WebLinkAboutMortgage_Dickman 4°—:---` STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court �shi ijear
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R77/509)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: - f I '
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought • .I•
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months I _/ r
before March 31 of each year the deduction is sought - 9* il' )`'
GIBSO• e e
See reve a for additional instructions and q r i cations. /J/�/ �/j����/
....1 artonpao bu1'e "' •�• .. re rse site) ' �.r7, X •_�eJC./ e '(/"�
�,./r Key - /->e.,desalt Pagan= 1
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�� �/ /. / a tee I -x 0 416.i(27t ` - /// (O ..•• .T -. •of real property as of Mo�page I.rt.:.Indebtedness unpaid as of Mortgage/�CC000rtrtyy p�dgbtedness unpaid as of Is the applicant t e sole
March 1,anent year Marr3r 7. . year date p(apP COD legal or equitable vanM
C�Jx// ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other flan spouse,indicate with wham
If name on retard is different than that of appfecam,indicate below'. Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
r Mobile Home(IC 6-1.1-T)
Name of mortgagee or contract seller -
if '
Address of mortgagee or contract seller( and street city.slate. -•ZIP...,
Name of assignee or other owner or holder of mortgage /////////yyy
Address of assignee(number and street City.state,and ZIP code) i / // ' E d* cc // , Ina_I
• Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
manly in Indiana? ❑ Yes ❑ No f o co ❑ Yes El No
COUNTY AUDITOR
Deduction approved in the amount of
20- b1L-IL1/!,V(1n/��j✓1N/�lG 20 20 20 20 I Signature 7194/ay /' r County Date(month,day,year)
I/We /) ling information is true and correct and that the applicant is a resident of Indiana and
owner / ��� lication is filed.
,r•••/ i Date(month,day,year)
•.... 4Co•lrf'cn (numb
Full resident of t( unWer and a7y, r and ZIP j /
/n 7e /f=-�r a - o 9 gt L l &nX ct1 7/V P x/761 i_
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 1 Date(month,day,yew)
Address of authorized person (number and street city,state,and ZIP code) .