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HomeMy WebLinkAboutMortgage_Ziliak (2) ;a,.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN S couptg� Downship Year " i: FOR DEDUCTION FROM ASSESSED VALUATION 1 { IH 1 q ._si.p- State Form 43709(R11/6-09) 1 ��sJJ� 9.J11J� _/ prescribed by Department of Local Government Finance ws7RUCnoA/s: MAY 1-3 2014 File Mark Form fried with: 7o 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 /I�❑ County Auditor 2) Mobile/Manufactured Homes not assessed as Real Property Must file during the hve r n before March 31 of each year the deduction is sought . GIBSONCOUNTYAUDIT@R Coumty Retorder See reverse side for additional instructions and qualifications. 11(owner or co rrma buyer m re side) T istrut moor tl ton number Pag Hegel, 13 oq- -o©\ . ?39-�f 1 4 c � Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of is the applicant the sole March 1,anent year March 1,current year date of application legal or equitable owner? //4/6,a.C J 0J ❑ Yes ❑ No If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom It 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 mortgagew contract seller 1�/G�.[� - Address of mortgagee ct seller(number and street a 1 (�1/ Name of assignee or other owner or holder of mortgage �� L.+"1`I 31 GOo Address of assignee(number and street airy,slate,and ZIP a Iy''_ 1/��( Does applicant own property in any other If yes, 1,4 4 3 deduction been requested on property mumy in Indiana? ❑ yes ❑ No nt Yew ❑ Yes ❑ No Deduction approved in the amount of 20 20 20 20 20 20 20 Signature of County Auditor - County Date(month,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 I contract buyer of the aforementioned property on date application is filed. s Signature i-r •n. 'l /� Date(month,day,year) Full / - I:.. _A. apptrant( umaerand sheet n11;sbte,and LPCVde) / �cjP 2 kr ST?rar2u19 / e ,l• .�.ce er AL,' �7� r e- - a by Addy executed Power of Attorney or by IC 6-1.1-12-0.7 / Date(month,day,year) Address of authorized person (number and steer,city,state,and ZIP code)