HomeMy WebLinkAboutMortgage_Gilmore MFG.. - STATEMENT OF MORTGAGE OR CONTRACT INDEED )bc-t'fo g l lD t1* --. hip Year
FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R71/6-09) y I \4 4
Prescribed by Department of lad Government Finance I
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File Mark
INSTRUCTIONS: - t�.22 A ditor ciadd
To be filed in person or by mail with the County Auditor or County Recorder of the county where the Io7;aI�1�l' 't� rywNv
Filing Dates: 1) Real Property Must file during the year for which the deduction is sou� I • A County Auditor
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2) Mobile/Manufactured Homes not assessed as Real Property.Must file u g - �
before March 31 of each year the deduction is sought - .mmi�_ • County Recorder
See reverse side for additional instructions and qualifications. oUNj' A
Apprran�Sowror oorwac buyer-see restit&os on rem side) n
/� ct31.0 1LX1R �Y Ml t}'L� CO1 GC—I
T number/legal description Rernrtl ntanbux Page maMei
Key 6-/r-ia -30/- oo a. h -ease- do /t / '9/
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1,amens year March ,cortent year date of apPfoaticn legal or equitable owner?
❑ Yes ❑ No
If no,what Is It/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name reard'e ddierent than that of a Indicate below I / I Is the property in question:Annually Assessed
�. C+.2 �� Vi / '�. Ropem ❑AnnuallyAseessed
t ./ Mobile Home QC 6-1.1-7)
Name of mortgagee or seller , •.0 P .Allao—
Address of mortgagee or contract saber(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any other If yes,what co r been requested on property
county in Indiana? (/�//�)
❑ Yes 0 N Drawer NO...2/ 1 ❑ Yes 0 N
Deduction approved in the amount at.. Card NO. F 1 l
20_ 20 20 Card
_ 20
I I I
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 aforemention property on date application is filed.
Signature .- Date(month,day,year)
Full �.:�rI'dress o:.4.3e/"
t(number nil street city,state,and ZIP code)
P• authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state.and ZIP code) .