HomeMy WebLinkAboutMortgage_Allen (3) t:'":. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
m FOR DEDUCTION FROM ASSESSED VALUAIYONj - i Fi
f'c Slate Form 43709(R11/6-09) 1188�L--ii
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: ,1 U 1 O Z O It, Form Acrd
To be filed in person or by mail with the County Auditor or County Recorder of the couniY ere the properly is located.
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 uring th twe )-months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for add' • ;l instructions and qualification . GIBSON COUNTY AUDITOR
Applicant(owner or con, .,b fir- restrictions, .verse ,e //
Taxi Istria . / Key nu r/legal d—•ption Record tuber Page number
pill �� o-d b-0a -y4D/ -acct. ISS-f 3 ON 2 33S
Assessed value of real properly as of Mortgage tract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appli ant the sole
Mardi 1.anent year Mamh ypat date of appGmtion legal w equitable amen
U COO ❑ Yes ❑ 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 the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
1 Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller �
Address of mortgagee or contract seller(number and street,city: te,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,ray,state,and ZIP code)
Does applicant own property in any other 'Ifyes--'-..county? - What Taxing District? Has this deduction been requested on property .
county in Indiana? ❑ Yes___r for current year ❑ Yes ❑ No
1� COUNTY AUDITOR
�11\\Cl NO hao .
3 20 20 20 20
Cal a \o . � 48 c
y 11 I County Date(month,day,year)
_ �3 :rA �Iail A.
I. .._,.erdly 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.
\Siy9_—na owne s(W rygrge) Date(month,day,year)
Plxa resid address of app t(nuumber and street,tidy,state,and ZIP code)
IIIXXX///___ 1 ctynes5a- Oo zk ,A C 1-6 7-43 47 (0 I3
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 sheet,city,state,and ZIP code) .