HomeMy WebLinkAboutMortgage_Nolcox r` STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATIOIelilk
�(_.1: t- State Form 43709(R11/6-09)
Prescribed by Department of Low Government Finance
INSTRUCTIONS: ,� p
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. F on fi f I7 d PS 2014
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
before March 31 of each year the deduction is sought - • idea
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
(o al
or ntraa buyer-see on reverse side) //�) (7
Record number P n
/ car-/ -mod ,_3D0- pD/. sit- 4(777 070%3 ad'
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of is the apptI it the sole
March 1,astern year March 1,current year data of ap "'/^� legal a equitable owner?
//U6) ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone ether than spouse,Indicate with whom
If name on record is different than that of applicant,indicate below Is ih property in question:Annually Assessed
eel Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller //3
Address of mortgagee or contract seller(nri and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street Sy.state,and ZIP code)
Does applicant own property in any other If yes,what county? - What Taxing District? Has this deduction been requested an property
county in Indiana? ❑ Yes ❑ No for current year?
❑ Yes ❑ No
Deduction approved in the amount at
Drawer NO.. 13
20 20 20 Card:NO. ..3V �J
_ 20
Signature of County Auditor l� oath,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.
4 Signature( rs 5tl15er name) Date(month,day,year)
Full resident address of applicant(number and street aTy,state,and ZIP code
(4 3o F- 3 so s �t � &1/1k-
Person 4�1pi o
Person authorized by duty executed Power of Aey or by IC 1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and sheet city state,and ZIP code)