HomeMy WebLinkAboutMortgage_Greer are STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS co T Year
aiSi FOR DEDUCTION FROM ASSESSED VALUATION ';
` u f.�• State Farm 43709(R11/6-09) :'
Presoibed by Department of Loml Government Finance
INSTRUCTIONS: FEB g e1Ma�1`14
Form Iced with:
Ib be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: f) Real Property Must file during the year for which the deduction is sought • It �7--- -•••amr
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months •air-111C ryry
before March 31 of each year the deduction is sought - GIBSONCOU. Y••UDITOR err
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyeZe r7rtieleitintevetse side) &t 3 number
• D ca(7 description Record number
,7
23 - /o/ -000. 76, 3 - oo 4 0/4 Page
/3 _7K5
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the apprrcant the sole
March 1,arms year Mardi 1,carrem year date of appGcotion legal or equitable owner?
I I 5/ pot ❑ Yes El No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mohler Home(IC 6r1.1-7)
Name of mortgagee or contract seller
W"" •'rte
Address of mortgagee or contract seller(number and sheet ray.state.and ZIP code)
Name of assignee or other owner or holder of mortgage �`}, p �p �-/
Address of assignee(number and street,city,state.and ZIP code) Drawer J i,Jp-h r l. /�•+�'-v"^/1'--7•cily�I--• --_
Dees applicant own property in any other If yes,what county? . NO �'`�/ 5 tested an property
county to Indiana? ❑ yes ❑ No 1 Yes ❑ No
co Card NO. 705
Deduction approved in the amount of.
20 20 20 20 20 20 20
Sigrattra County
�ci t/t.Ci County Date(month,day,)ear)
I I We certify under the penalty of perjury above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner 1 contract buyer of the aforementioned property on date application is filed.
, AS name Date(nimdr,day,year)
K
44' ent •ms • a•.• ••'t numbers • � S5 cR)c sbfe,•end ZIP code)
ut 7 8 A S. GU� 7„1,..., Oo �a(.D 4-`17&6 0
authorized by duty executed Power of Attorney or by IC 1.t-12-0.7 Date(month,day,
Address of authorized person (number and sheet city,state,and ZIP code) .