HomeMy WebLinkAboutMortgage_Bertram eF a.' . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION E
State Form 43709(R71/6-09)
Pi saibed by Departmerd of Local Government Finance
File Mark
INSTRUCTIONS: hu,,pr1 ,1
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. iLL7 14
Filing Dates: f) Real Property Must file during the year far which the deduction is sought. 9 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months /1�
• before March 31 of each year the deduction is sought J G...-ctircorder
See reverse side for additional instructions and qualifications. G I BSON COUNTY AUDITOR
Appricanr or contract buyer-see restrictiwrs re side)
•
T - g 0. 'a Key numbed/ al description Record number Page number
_i D' flr '3L- lop -0c 5o -o ate l3 .5 taa9
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract ind btedness unpaid as of Is the applicant the sole
,terms year March 1,current year date of application legal or rrr�(}egq��ru�u�itabCle owner?
r3� O�b Da 1 ❑ 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 apparent indicate bebwc Is theepprroperty in question:Annually Assessed
Name of mortgagee or contract setter (�
C Cl
o or contract seller(number end street.city,state,and ZIP code) /- -' ✓• •
Name of assignee or other owner or holder of mortgage j1( 0+� •-
Address of assignee(number and street,city,slate,and ZIP code) - a` IC
-O' �(/`
Does applicant own property in any other If yes,what county? What Taxing District? y
county in Indiana?
❑ yes VNo CA.(a`p.
COUNTY AUDITOR _
Deduction approved in the amount of
20 20 20 20 20 I 20 20
Signature at County Auditor County JI 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 contact buyer of the aforementioned property on date application is filed.
,Signal re owner's Ai nam�e(')I'�',u,`.rp'','s'p`'yL� ✓��(2j�`'�`',,`',^ '` Date(month,day,year)
FWYesme address of applicant(number and street,�;state,and ZIP code)
4 4926 E toso S -av6stadt IN 41639
author ed by duty executed Power of Attorney c by IC&-t.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)