HomeMy WebLinkAboutMortgage_Ping (2) ar.- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Cisi FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/609)
Prescribed by Department of Local Government Finance Finance '$� E
F INSTRUCTIONS:
7b be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form Am with:
(((1'�,�(1
Ring Dates: 1) Real Property. Must file during the year for which the deduction is sought A F M l .CoZnryAuditor
2)Mobile/Manufactured Homes not assessed as Real Property Must h7e during the twelve(12)months
before March 31 of each year the deduction is sought El County -ecord
See reverse side for additional instructions and qualifications. a� ern/.
contraC bu
,
_i o GIBSON COUNT • I 1 • -
Tab ( p-•. Key' '°. /legal dnsaipdon Record number Page number
-54
real •• of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appli ant the sole
March t•. .. - I Marts 1•current year data of appr tan legal oO itable
O /�/ yes 0 No
If no,what's his/her exact share of interest? If owned with someone other man spouse.indicate with whom
If name on record is different than that of applicant,"udicate below: Is property in question:Annually Assessed
eat Property ❑Annually Assessed
• Mobile Barra(IC 6-1.1-7)
Name of mortgagee or contract seller ( xo
a
Address of mortgagee or contract sell¢ and street city,sta code)
Name of assignee or other owner or holder of mortgage - - _ -/�^C/ �]1
Address of assignee(number and sbee4 city,state,and LP code) 1 • 6/••'•
Does applicant own property in any other ❑ No If yes,what county? ... /5/.•' es property ed
county in Indiana? r� .. ..• .
D Yes Card NQ. ❑ No
Court
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/contract buyer of the ention property on date application is filed.
signasae ra Date(month,day,year)
Fu 'fi�e ia of a 'pant u ra street city,sta�t,�'°ZIP rode) nn /
Cho O �i (/�kllea �J �5.� V/ 620 S
authorized by duty executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,My,state,and ZIP code) .