HomeMy WebLinkAboutMortgage_Lasley et,,,..,,..., STATEMENT MORTGAGE CONTRACT INDEBTEDNESS County Township Year
� FOR DEDU CTIO N F ROM AS SES SED VALU YYYO iL
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: (,,Ip pp ''77 �r
To be filed in person or by mail with the County Auditor or County Recorder of the coutg lvhZe the pr,perry is located. Form Ned with:
Filing Dates: t) Real Property Must file during the year for which the deduction is sought. County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must during a -months ty
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
. .3l owna or conhaa buyer- an re sd
/ ' . � /
Key number/ desaipt6n I fL, number Page number
• ,P)' • o 11- 15-1Cb 10•3.'aa-a'7 koIa, cDlo Coe
Assessed value of real property of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appli ant the sole
March 1,area year MMaarrcrhh 1.cement year data of appfimtion legal or equitable owndl
❑ Yes ❑ 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 afferent than that of applicant Indicate below Is the property in question:Annually Assessed
❑Real Property ❑AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller - ,1 /7 I ,
Address of mortgagee or contract setter(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,coy,state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? rr
❑ Yes ❑ No for current year?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20_ 20 20 20 20
Signs CamtY Auditor v Canty Date(month,day,year)
I/ e cer(^rtifyy 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 l contract buyer of the sr r ementioned property on date application is filed.
$q��r,�y(y're(o nano) 1 Date(month,day,year)
tA_VQ-
Fer
W ofa.. m a .street r redL
—1 7 A— , i'� �m ILA l7/a7D
Person authorized by duly executed Power of AtlorpeVSr by IC 6-1.1-12-0. ) Date(month,day,year)
Address of authorized person (number and sheet,ci',s,)state,and ZIP code) .