HomeMy WebLinkAboutMortgage_Durbin r.��"Y;?'.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year _
= FOR DEDUCTION FROM ASSESSED VALUATION g / T
P., State Fo m 43709(R11/6-09) psi AA
Prescribed by Department of Local Government Finance y
He Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. A-4' 10 X814
Filing 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 file during the twelve(12)months Sa > ecorder
before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. G I B S O N COUNTY AUDITOR
or contract buyer-see restrictions on reverse sid
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Ta •• DistrxY r1 Inumber/ descriptlon Record number Page number
ra4fvr - �a—‘a -3oa —oo. , atZ —� r)ol3 506
vaWe ol real WoPertY as of
Mortgage/Contract debtedness unpaid as of 1 Mortgage I Contras lode ess unpaid as of Is the applicant the sole
I.anent year March t,cortent year,,,•� date of application legal or equitable owner?
�0—QuJV yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,Indicate with whom J
If name on record is different than that of applicant,Indicate below. property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Hone(IC 6-1.1-7)
Name of mortgag0 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 ,.°J
Drawer NO "`0 18
•
Address of assignee(number and street,city,state,and ZIP code) -rrr.�/-'/l�(��J/C�
Does applicant own property in any other If yes,what county? Card NO _ + ✓ I co p••
county in Indiana?
❑ Yes CO'No 1 s It No
COUNTY, �
Deduction approved in the annum 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 mentioned property on date application is filed.
Sig rs lud+Jy ) Dale(monde,day,year)47
Pin
resident epaddre�ss Jro�offf L t(number a�t city�sltate,and ZIP coodee) L /� T J ?
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P authored 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) .