HomeMy WebLinkAboutMortgage_Settle OSTATEMENT OF MORTGAGE OR CONTRACT INDE i�SS un Townshi p Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Lod Government Firence
INSTRUCTIONS: MAR 5 2014 File Mark
b be filed in person or by mail with the County Auditor or County Recorder of the county where the Form�� `
b N h property is located
Fling Dates: f) Real Property Must file during the year for which the deduction is sought COun Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during A9 the ty
before March 31 of each year the deduction is sought. GIBSON COUNTY AUDITO-, County Recorder
See reverse side for additional instructions and qualifications.
nt(owner or contract buyer-see restrictions on reverse side) (� -�-y1� ,,- `\ �,.� (�
rg I Key number/legal description Record number Page number
(2- 15-2Z-zoo (nI. 2CB - noo aO//T/ 6s/7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of I Is the applicant the sole
Maude 1,and year March 1,commit year date of apprration I legal or owner?
equitable owr?
l 5 000 ❑ Yes ❑ No
If no,what is Ns I 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
yal Property ❑Annually Assessed
• Mobile Home(IC 64.1-7)
Name of mortgagee a m0(ract;eyl?I)
Address of mortgagee or contract seller(number and street 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 VP code) 1 Q 1�l/ 9
Drawer N
Does applicant own property in any other If yes,what county? • Wh / / property
county in Indiana? t/�
❑ Yes ❑ No Card NO. ❑ No
COUNTY AUL l•
Deduction approved M the amount ob
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.
X wnahherhn.) 3/S day,year)
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Full ent address d applicant(number ands tact ,,state,and ZIP code) /_ ,L 7/�/ V
Person/5 9ed�d�y AP1 c/7`y _LAT K !(o CO� Date(montl+,day,year)
Address of autorved person (number and street city,state,and ZIP code)