HomeMy WebLinkAboutMortgage_Peck STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
•
E FOR DEDUCTION FROM ASSESSED VALUATION
C.J State Form 43709(R71/6-09) ${� g
Prescribed by Department of Local Government Finance r K
INSTRUCTIONS: Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. ,ipva1r,qp+,L
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought ❑F re�u-Y iJ�ZIIIY
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 - ❑ County Recorder
See reverse side for additional instructions and qualifications.
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Appficant(owner buyer-sea a re
Ja K+-ver a en� L) ( ex92_ GIBSON COUNTY
AUDITPR
Taxing District Key •, ber/legal desoip
Reand P.... . •
Assessed value d real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness I paid as of Is the appfrant the sole
Mandl 1,o rent year March 1anpy yea( am data of appGmtiarm legal or equitable owner?
❑ Yes ❑ No
If ra,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is&Parent than that of applicant.indicate beLaw� Is the property in question:Annually Assessed
( ❑Real Property ❑Annually Assessed
Mobile Home(IC 611-7)
Name of mortgagee or contract seller
Address of mortgagee or contrail seller(number and sbee4 city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage - - 2
Address of assignee(number and street,city,state,and ZIP c d(9 s
Drawer NO a
Does applicant own property in any other If yes, a� this deduction been requested on property
county in Indiana? ❑ Yes ❑ No i f/1..! rat Y� ❑ Yes ❑ No
Card NO. �Q��p��L/�\'y��r/����
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 I contract buyer of the aforementioned property on date application is filed.
re(ow+refs hA Date(north.day,y.year)
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FTC (0 IN 1--ppOpn6xumbaral/ r�ueet?N sate.a fie/code) Hata- � I r)I 3 /•1 _ .
Person authorized by duly executed Power of Anomey or by IC 6-111..1/-1122,-00.7101^ `t _Ip Dace7(monN.dal:leaf)
Address of authorized person (number and street,city,state,and ZIP code) • -