HomeMy WebLinkAboutMortgage_Fromme STATEMENT OF MORTGAGE OR CONTRACT INDEBWRE o Township Year
FOR DEDUCTION)FROM ASSESSED VALUATION
.:it`• f: Slate FOrtn 43709(R11
Presmbed by Department of Local Goverment Finance
JUN 1 1 2014 File Mark
INSTRUCTIONS: Forth filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the roperty 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 during $j the
before March 31 of each year the deduction is sought GIBS NCOUNTYAUDITOR County Recorder
See reverse side for additional instructions and qualifications.
T I� Key number desaip" Record Page number
ad c (i''n'y �L 6(0-0G-D6-dot-ate SS&-O I7 ki a a io
Assessed value of real prapa$as of Adage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app5cant the sole
Month 1,aumnt year Maw-'l O(ygarr� date of application legal or equitable owner?
C�17 in ❑ Yes ❑ No
If no,what S as/her exact share of interest? I If owned with someone other than space,indicate wah whom
If name on record is different than that of apt,indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
. Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
5
Address of mortgagee or contract setter(number and street city scat-,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
tat county? - waat Taring District? current been requested on property ,
for
❑ yes ❑ No
Drawer NO...Paz/
^ �� COUNTY AUDITOR
Card NO. ( 1.- )
20 20 20 20
I • I
Signature of ' A _. l// 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/contract buyer of the aforementioned property on date application is filed.
\iSoignaWre wee'f ftliname) Date(month,day,year)
f Fug resident address of t(number and street cry,state,and LP code)
'' 73-58 4/ SQ t 6T f{4z/men -,141 117640
Person authorized by duly executed Power of Attorney or by IC 6-1A-12-0.7 Date(north,day,year)
Address of authorized person (number and street city,stare.and LP code)