HomeMy WebLinkAboutMortgage_Wallace (20) b�._a_ _STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
- State Form 43709(R11/6-09) '
Prescribed by Department of Lod Government Finance
INSTRUCTIONS: i :l�•=I'!
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located.
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought. Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months A
before March 31 of each year the deduction is sought - OCOdflty Recorder
See reverse side for additional instructions and qualifications. /)r
App
(owner acontr ct buyer-�resa^irLOns onreve/rs'esiide) GIBSO/JN�NCOUNT�y AUDITOR
CAL/ / /` l/{�J
Ta District Key number/legal description /' ,/ -] 5� Record`�'�/�,,Js P n��l7mber
.y1.1 a6n - /a-67 — YQT -003 r-37g— Q .)-.0 ( i /�
Assessed vahxe areal property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year Mardi 1,co date of application legal or equitable owner?
;J p
to 5 d ❑ Yes El No
If no.what is his/her exact share of interest? It owned with someone other than spouse,indicate with whom
If name on record is ddferent than that of applicant.indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /V}-Cid
Address of mortgagee or contract seller(number and street,city,state.and ZIP code) ��
mort
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet ' -
Dra�� 0Oy�
Dces applicant own property in any othe
Drawer cr \O.}{!..!� - rid? Has this deduction been requested on property
•...••.-. for current
many m Indiana? year?
❑ Yes El Yes ❑ No
Card NO. ...• q�� —
Deduction approved In the amount of CQ_lAI,LL
20 20 1 zuu 20 20 20
Signature of County Auditor ., County v'N_t At
County Date(month,day,year)
We
I
I We certify nalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner contract • - of aforementioned property on date application is filed.
Signnnaatu -/.• .� r. /} Date(month,day,year)
F/ t(numbe�r((��nA10 sfre�t a7y,state,and LP node l ,r/j i 67 D
•- authorized by duly executed PobeelUf Attorney or by IC 6-1.1-12-0.7 Data a((_`month'h,,day,year)
Address of authorized person (number and meet dry.state,and ZIP code) .