HomeMy WebLinkAboutMortgage_Kelley , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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�l FOR DEDUCTION FROM ASSESSED VALUATION
-.rr- State Form 43709(RD/6-09) F I LE
Prescnoed by Department of Local Govemment Fiance
INSTRUCTIONS: gad �y
b be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. l r 11 '[, /Q 14
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought Lr J1 _Coounty 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 - - •er
Yea soug '',r,,n r•.Iill.- .
See reverse side for additional instructions and qualifications.
GIBSON CnI1N
App&ean (owner or contact buyer-see on reverse side) TY gUDITOR Key /legal bon
1 / `ry�c f
A(0'1!( - ° 8 _ iocl - oo1• Li el -oil e,0(q Page number
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,current year date of appricaton legal or equitable owner?
80 000 ❑ Yes El No
If no,what is his/her enact share of interest? If owned with someone other than spouse,Indicate with whom
If name on record is different than that of applicant.Indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller /IOW td
Address of mortgagee or contract Seger(number arTelftercbritate.and ZIP
Name of assignee or other owner or holder of mortgage
Address9t (number and sheet, ,,state,and ZIP code) _ _/_/_'/� ___ _
Does[[a77pplicant own property in any other _'?/,If yes,what county? • .What Tadro /OI
county in Indiana? Drawer NO. C/!'(� n
0 0
COUNTY AUDITOR Card NO. • F
Deduction approved in the annum M:
20_ 20 20 20
Sgrai i{5 Yr1.1M— County Date(rtnrah,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.
�! Slgnaprna(o rartre)' ,�0 � Date(rtwrdi,day,year)
/\ It//E�Ardl, name)
Full en add pprrant nun ra w Ty,state,and ZIP
I £O 1 e. e9 , hjm( A 47670
Person authorized by duly tied of Attorney or by IC 6-1.1-12-0.7 Date(month,day,raw)
Address of authorized person (number and street,city,state,and ZIP code) •