HomeMy WebLinkAboutMortgage_Sandifar (2) — . STATEMENT OF MORTGAGE OR CONTRA TE County Township Year
Al'.f.�r.;;' FOR DEDUCTION FROM ASSESSED VAL II N �{
-r 1: State Form 43709(RI1/6-09) g
Prescribed by Department of Lod Government Fuance
File Mark
lNSTRUCnoNS: MAR 1 4 2014
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form filed with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is ht. County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property e Y�'f'^^�`elve(12)months
before March 31 of each year the deduction is sought County Recorder
GIBSON COUNTY AUDITOR
See reverse side for add'.net instructions and qualifications.
Applicant(owner or.. ...cub r-see
, o side)
bet/ de-carnation
Record Page
"f l 0 It [ / J -i — /O RJ-co-? ., 0 f /
Assessed vale of real property Mortgage/
Contras indebtedness unpaid as of Mort gage/Contact indebtedness unpaid as of Is the applicant the sole
Merle t,current sear
March 1, O date of apprcation legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? I tf owned with someone other than spouse,indicate with whom
If name on record S different than that of applicant.indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Mobile yAssessed •
Mobile Hone(IC 61.1-7)
Name of mortgagee or contract seller --e V
Address of mortgagee or contract seller(number a steer.city,state,and ZIP code) ll/..
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,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? ❑ Yes ❑ No for anent year?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved N the amount of.
20 20 20 20 20�n/ 20 20
Signature of try imr i l {r ''�`''//�"/�'/f��� County '1/`/ / Dale(month,day.leer)
I/We certify under the penalty of pe`rju�ry ythattt 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.
nature(./ /.:-me / Date(month.day,year)
F J resident address of at/pecan number t a y,state,end ZIP code)
j/�� /17 W Virlt (hh'4a C4, /,tJ Y7& O
Perron audor�d by duly executed Power of Anomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city-state,and ZIP code)
1