HomeMy WebLinkAboutMortgage_Bradshaw (2) n. STATEMENT OF MORTGAGE OR CONTRACT I E punt y Township Year
� � : FOR DEDUCTION FROM ASSESSED VALUATI
State rronn 43709(R11/6-09) AAAAAA
Presoibed by Department of Ind Government Finance
INSTRUCTIONS: MAR 1 4 7014 File Mark
with
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property' Arica . Form filed '
Ming Dates: 1) Real Property Must file during the year for which the deduction is sough�t-(n,,,,•, ,0 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must Re drJp )months
before March 31 of each year the deduction is sought GIBSON COUNTY AUDITOR ❑ County Recorder
See reverse side for additional instructions and qualifications.
t(• •r or contract buyer- ::restrictions onra 4 tee) /
• �.�t--.l L *i desolation/2/, 7AA-1 ) Record number
Taxing Dis Key /legal 8 -03 o a -on „3 l0/ -o a ln a o 4' Page 7 7 Er A Assessed value drd property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appttrall the sole
March 1,one year March 1,current year date of appficatlon legal or equitable owner!
9'9 000 ❑ Yes ❑ No
If no,what is his/her exact share of interest? tf owned with someone other than spouse,indicate with whom
If name on record is different than that of ape/rant.indicate below. Is the property in question:Annually Assessed
0 Real Property ❑Annually Assessed
Mobile Hone QC 6-1.1-7)
Name of mortgagee or carted seller
,3
Address of mortgagee or contract setter(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage r — _
Drawer )1r --�
Address of assignee(number and street city,state,and ZIP code) o. Q/y.....
Does applicant own property in any other If yes,what county? at Tax ) 1
county in Indiana? ❑ Yes ❑ No Card NO. ... / ... 'Y
T I No
COUNTY AUDITOR
Deduction approved in the amount of
•
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.
Signature
44 d ✓ TA ./ Date(month,day,year)
Fun resident of appfoant(number and street city,state,and ZIP tee)
x946 N. ltolI St F><. /Iran°h .ZN. Y7.rik.
Person authorized by duty executed Power of Attorney 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) .