HomeMy WebLinkAboutMortgage_Conway STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County IF Iw1ship
- .... i FOR DEDUCTION FROM ASSESSED VALUATION
To t, State Form 43709(RI116-09) 1 gJ
Prescribed by Department of local Government Finance
INSTRUCTIONS: Fj tJNat.3 2014
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Forth filed with:
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. ;h/ • s. r;r •
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months "°-' ��''mPf
before March 31 of each year the deduction is sought - GIBSO ' O+' ''v vitOR
See reverse side for additional instructions and qualifications. -
Appfcant(owner or contract buyer-see restrictions on revers • e) 1 Th s
numbstr/legal desorption Record number Page number
:..At _, a o •- -l_ - s . -b • . Co - ._ O I I It._ -
>-!•value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract rode•edness unpaid as of Is the applicant the sole
March l lica chum year March 1,aurr••-••- date of application legal°t'itable owner'?
I(5 ( , a�a (�C}l/es ❑ No
If no,what is his/her exact share of interest? ,.. i someone other than spouse,indicate with whom 1
If name on record is different than that of applb'"' O property in question:Annually Assessed
I Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contracts Q... .
C.-TS DI-cps C,
Address of mortgagee or contract •'
o w n e r C:aiU \O• •.•••
Address of assignee(number and sheet,city.state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? for curter year?
❑ Yes Into ❑ Yes tR10
COUNTY AUDITOR
Deduction approved In the amount at
20 20 20 20 20 20 20
Signature of County Auditor County Data(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.
F lVesre(o full 4 t) / Date(month,day,year)
4 </`
F - ant I t• 1(number antl(sfn t, te, Lpcptle)
/l! S .l ZZ+III`-'yTll,ku�+tr� �n c.{ 7 (0 39
Verson aubic•ici by duty executed Power of Attorney or by IC 6-1.1-1 .o. I Date(month,day,year)
Address of authared person (number and street.cM,slate,and ZIP code) -