HomeMy WebLinkAboutMortgage_Wallace (3) l.a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
` FOR DEDUCTION FROM ASSESSED VALUATION
• f- State Form 43709(R11/609) pgp�f
Prescribed by Department of Lod Government Finance 110 MBr
INSTRUCTIONS: go�f(�ap
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. H r R V 9O 14
Ring Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must fie during the twelve(12)months I-1
before March 31 of each year the deduction is sought. n/Q et
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See reverse - e for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Apprieant or contract buyer-sRe resuirbwts on reverse side)
GT ong tract /[// Key nu ption Record number Page nom
at.�G'- a(o - 19./8 - 30.1, .. o00 . lD9 - ooh aar �l 3d
Assessed vakre of real °oe�y'as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appr�nt the sole
March 1,current year (/ March 1,anent year date of application legal or equitable owner?
ql 8 Q o ° ❑ Yes ❑ No
If no,what is his/her exact share of interest? t If owned with someone other than spouse,indicate with whom
If name on record is different than that of appfrant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑Armually Assessed
/ Mobile Home(IC 6-1.1-7)Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state,and ZIP code) _---
Name of assignee or other owner or holder of mortgage
Drawet::
Address o_ f as4gn (number street,city,state,and Zi code) /�/J L�,-�
Does(applicant own property in any o If yes,what county? • What Tarring Distrii ,...........
,.Y.• r ''•••
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countyinIndiana? Card
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
5r)of County.ty LW
Auditor r r County Date(month,day,year)
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/contract buyer of the aforementioned property on date application is filed.
Sigremre(owners M name) Date(month,day,year)
,e (,t9a/S�t '
I Full resident address of applicant(number and -- city,state,.. •ZIP red: s
r r Q.i(,�(iL-
/� / �� i I �. /-ice ./ ._�/ � �.
Person authorized by duty executed•••rl 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)