HomeMy WebLinkAboutMortgage_Clark (7) sT- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
A''.1 FOR DEDUCTION FROM ASSESSED VALU T L
t: State Form 43709(R11 1 609) 1
PnSaibed by Department of Lod Government Finance I
File Mark
INSTRUCTIONS: �,1�y (1 p ��7 f1�,1
To be filed in person or by mail with the County Auditor or County Recorder of the tbwrA a8 ftailcpefly is located. F Rte with:
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 during the Ise 12)months
before March 31 of each year the deduction=sought //� _ ❑ County Recorder
See reverse side ibonalinstructionsandqualifications. GIBSON COUNTY AUDITOR
Applicant(owner jf- m o e)
T l/•Jix/,x^ Key numbs Igal lddesaipry Record Page number
I(y � �-/0 - 3(0 X200® oo3.7a3 oil( 1197
Assessed value of pmper•,y as Mortgage/Contra=indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1,cures year March 1,arrant year 1.40 emu,0 date of application legal or equitable owowner?(
El Yes ❑ No
Et no,what is his I her exact 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(IC 6-1.1-7)
Name of mortgagee or contract setter ..
65'6
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
C/-A/2-«, DPc c A
minty? • What Taxi District? Has this deduction been requested on property
I - I I n for current year? ❑ yes
I ❑ No
COUNTY AUDITOR
20 20 20 20 20 20 20
Signature of Camiy r County Date(month,day year)
t/^-Iwo !T{J icf
II 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.
(o rmlye) /J/J f_ Date(month day,year)
ull ent address of applicant(number and street,city,state,and ZIP code) S-171 i Al
1/40 3854 S , `700 w , OwL,jsvo-LE TAB, At) 66,5
Person authorized by Gay exe=rted 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)