HomeMy WebLinkAboutMortgage_Burnor bSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Townsh' Year
` FOR DEDUCTION FROM ASSESSED VALUATION
-. State Form 43709(Ri i l 6-09)
Presaibed by Department of Local Government Finance
File Mark
' INSTRUCTIONS: MAY F, .01,
Yo be filed in person or by mad 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 Ei Co r• Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)mon y • 4 –_.4j
before March 31 of each year the deduction is sought - . ' w War EaI4t County Recorder
See reverse side for additional instructions and qualifications.
GIBSON CO ! e
Apprrant(owmgr or contact buyer-see/es4ions verse side) X
Ta District Key number/ description Record number Page number
value AA_Iia' 3&,_ Jo0, 00.4 , a90 -0ay � O ) k 3 a 7 0
March 1 Hof reel property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
year March 1,cement year date of appffcation legal or equitable owner?
AI 70o0 ❑ Yes ❑ No
If no,what's his/her exact share of interest? 7 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
0 Real Property ❑Annually Assessed
• /1 Mobile Home(IC 61.1-7)
Name of mortgagee or contract sell&Gt `// // ,r
Address of mortgagee or contract seller(number and.street.',eV_ te.and.rro _— - /-- -
Name of assignee or other caner or hol p e cox 'A') - . ..
Address of assignee(number and sbeee/- 01'`Cl 01(1 ,,
74.E f
Does applicant own property in any othe _'.`—r(Q.QQ 13 - � }p' � /�'/(�/�� x orlon been requested on property
county in Indiana? El Yes U ❑ yes
Yes )1 ����/0 ❑ No
Deduction approved in the amount of s a I Q coo. 0 O
•
zo zo_ �(1 , I1 coo.
20
SigratuJe/�tnr e(rtnrVh,day,year) •
I
v��/ P
--r I We ce penalty o (Q I�` — 3 d 0 2nt is a resident of Indiana and
owner/contract buyer of the afo
1 ��� /�i
4.
Person authorized by dory executed Power of Niamey Tor C 6-1.1-1.-0.
' Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)