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HomeMy WebLinkAboutMortgage_Dearing (2) is.: _ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION �4 State Form 43709 Department nt of 6-09) L IL,P ��� Pnsaibed by Departrnem of local Government Pounce File Mark INSTRUCTIONS: i :.. lfiwie I , To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. El County Auditor 2)Mobile/Manufactured Homes not ascessed as Real Property Must file during the twelve(12)months b before March 31 of each year the deduction is sought - 1 2 t` -ecorder See reverse side for additional instructions and qualifications. 1'n GIBSON • TY AUDITOR •• D/ b rnra/cegal ,c//L/!/'w number Page number I y .. T.�,.j' pie ay) r yc /�-/orb- Lb/. - 4076 �' 7J% Assessed value areal property as of rtgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole March 1,current year March 1,current year date of ap O ❑legal equitable Yes ❑ No If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom If name on record is different than that of appecanl indicate below Is property in question:Annually Assessed Real Property ❑Armually Assessed ////'���� Mobile Home(1C 6-1.1-7) Name of mortgagee or contract seller Viii I / /®1 6�Address of nwtgagee or contract seller(nd city sta aannd ZIP code) Name of assignee or other owner or holder of mortgage Address of assignee(number and street dry,stare,and ZIP code) Does applicant own property in any other If yes,what county? . What Taxing District? Has this deduction been requested on property county in Indiana? I for current year? ❑ Yes ❑ No —_— ❑ Yes_ El No COUNTY AUDITOR Drawer NO Pv /q Deducdon approved in the amount at • 20 20 20 20 Card NO. ....2 Signature of County Auditor County �� / — 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 aforementioned property on date application is filed. re(owner's full name) Date(month,day,year) { da resident address r and sheet city,state,end ZIP code) t .3—©7 S• /,`rj rri,/n it f tv re t- .9ccoc4 rat! 976418 Person authorized by duly executed Power of Atlmrey or by IC 6-1.1-12-0.7 Date(month,day,year) Address of authorised person (number and street aty,state,and ZIP code)