HomeMy WebLinkAboutMortgage_Johns (2) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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(* � FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(Rut/6-09)
Resaibed by Department of Local Government Finance o
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INSTRUCTIONS: u-mmt. w 1�,'
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is local .
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. Count'Auditor
2)Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months A OdC57thfly
before March 31 of each year the deduction is sought. Recorder
See reverse side for additional instructions and qualifications.
Apprrant(owner or contract buyer- re�i: tio ns reverse side) � r
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GIBSON COUNTY AUDITOR
Taxi Key number/legal description Record number Page number
.26 — /y— all - /act - coo. 3 sy - oo Xo ' Y 17
Assessed value of real property as of Mortgage/Contras indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year Mardi 1,co year data of application legal or equitable owner?
/ DO C� 0 Yes 0 No
If no,what s hhis/her exact share of interest? If owned with someone other than spouse,indicate 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 Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(nurnbe and street,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Add of assignee(number and street.city,state,and ZIP code)
T N Ndi all 4_,E. 08 .gL
Dees applicant own property in any other If yes,what county? • What Taxing District? lies Ns deduction been requested on property
county in Indiana? ❑ Yes ❑ No — (far artem year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount at /n�� i
Drawer NO GO/
20 20 20 20 20 , I
Signature of�County/Auditor
� � �_ �` Cal•(]51/,�10. I - -go
I/We certify under the penalty of perjury that the above and foregoing information is true and correct t 50, "`�'
owner I contract buyer of the aforementioned property on date application is filed.
i ...ic Signature(a /s boll name) / / Date(month,day.year)
Full resident address of applicant(num rand street,sly.state,and code)
�� o.S —/a '� n E � ec r . $7o
rson authmrzed by duy executed Power of Attorney or by IC6-1.1.1-12-0.7 / Date(month,day,year)
Address of authorized person (number and street,ray,state,and ZIP code) _