HomeMy WebLinkAboutMortgage_Grimes (2) M aT` STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
f�m FOR DEDUCTION FROM ASSESSED VALUATION
_t..t= State Form 43709(R11/6-09)
Prescribed by Department of Local Cerement Fuama IF I L E 1))
INSTRUCTIONS:
To be filed in person or mail with the Court Auditor or County Recoder of the county where the Form filed with:
pe by ry ry ry property is located.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought MAR 1 , 2124 County Auditor
2) Mobile/Manufactured Homes not asseaced as Real Property Must Me during the twelve(12)months
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications. /, , army,
Aparxant( or see on re side) GIBSON COUNTY AUDITOR
Taxi strhp
Key number I at
description 001. Q (0 5 — O ,' Record 0 I Page� OeerO
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appfcant the sole
March 1,cvrent year March 1,current data of application legal or equitable owner?
sa 0 0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? tf owned with someone other than spouse,udicatd with whom
If name on record is different than that of applicant Indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Horne QC 6-1.1-7)
Name of mortgagee or contract setter
Address of mortgagee or contract surer(number and street . state, d ZIP code)
Name of assignee or other owner or holder of mortgage
Address of ee(number and street,city,state,and ZIP code)
. s her /! 8PT I9Pr
Dues applicant own property in any other If yes,what county? , What Taxing District? Has this deduction been requested on property
aunty in Indiana? ❑ No for current year? ❑ Yes ❑ No
❑ Yes ,
COUNTY AUDITOR Drawer N o
Deduction approved in the amount of O••••�•••'•
20 20 20 20 Card NO. to
it1or4yyz_al 05 ird tr DO Int. —
Signature of County r ty Auditor- County
I
We
I
I We certify 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 cwogntt�rsa�cttJbuyer of the aforementioned property on date application is filed.
KSig (wit utikinre) Date(month,day,year)
` l/
P Not
X Full resident address of appftcant(number and street city,,state,and ZIP code) T
, 11 I c)- \ 3 5. r:n c e 54; Pr i>I v e 4--04 1 n 4/7,4 71,
Person authorized by duly 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)