HomeMy WebLinkAboutMortgage_Michael . . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
frA"t FOR DEDUCTION FROM ASSESSED VALUATION
t State Form 43709(R11/609) T
Pnaaibed by Department of t.aml Government Finance FILE
E
File Ma
INSTRUCTIONS: I�,,,�1 �,,l�y�
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is locateri t "J""CUf
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)montl7§r
before March 31 of each year the deduction is sought "
JNIVG unty Recorder
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant( ner or contract
Record number Page number
4 alo - r 8 -i3 -cloy- oov . y,to-orb l� 1796
Assessed value of real progeny as of Mortgage/Contract indebtedness unpaid as of Mortgage I Camact indebtedness unpaid as of Is the epplrant the sole
Mania 1,anal year March 1,anent year date of application legal or equitable owner?
2D 300 ❑ Yes El 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 applicant.indicate below. Is de property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Borne(IC 61.1-7)
Name of mortgagee or contract seller - - . . —__ _ _ _ _ _
Address of mortgagee or contract seller(number and street,city.state,and ZIP code) ,,Sur 1(1 }-� 4- ai�t l(r,. _
Name of assignee or other owner or holder of mortgage ��Y min Igt/etj-
Address of assignee(number and street,dry,state.and ZIP code)
Iy - 1 -7gip
Does applicant own property in any other If yes,what county? • What Taring District
county in Indiana? ❑ No
❑ Yes
COUNTY AUDITOR 5/3 70l WD 42
Deduction approved In the amount ot.
20 20 ` 20 20 20
Sigra/ r tw 'hs -I_j Courtly
!I/We certify under the penalty of perjury that the above and foregoing information is true and
owner I contract buyer of the aforementioned property on date application is filed.
cSIg� (owzre(sJpl1 nanu2 Date(month,day,year)
�FUY reside drreeessss of applicant(number and street,tiry,state,and ZIP code)
o2oc S MAv.")Sr- R.)74ic4'1X- . 470Y0
Person authorized by duly executed 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) .