HomeMy WebLinkAboutMortgage_Hidbrader -� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
is y; -State Form 43709(R11/6-09) T
�;•„ / Prescribed by Department of Local Government Finance p ' t'
INSTRUCTIONS: FI Ma
To be filed in person or by mail. Form fled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. JUM--� OC��f}Auditor
Must be filed with the County Auditor or County Recorder of the county where the property is located ��LL44
on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the IL j'mW;
deduction is sought. GIBSON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side
Iidhrader, fMe- 772 . 4 le/4- K CJ,I/
Taxing District I Key number/legal description Rehr r e 'Peg G�atG � >s-r8 - l3 yea CCC . X99 C) (o ocU
•
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application p M �/� legal ore uitable owner?
• i/Ut 0 O9 •OD Yes ❑ No
If no,what is his/her exact share of interest? It owned with someone other than'spouse.indicate with whom
If name on record is different than that of applicant.indicate below: Is a property in question:Annually Assessed
Real Property El Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mo,gagee or contract seller nn
/�firn4n A/ rILdm ,/ /)Corp
Address ormortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other , yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? t for current year? ❑ ❑
I:1 Yes Q No Yes No
COUNTY AUDITOR
Deduction approved in the amount of: •
20 20 20 20 20 20 20
Signaturgnatur ofr y County Date(month,day,year)
V
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.
Sgna re(owner's full Lk // / / / Date(month,l year)
Full resident address of applicant(number and street,city,state,and ZIP code)
3w A). Main Sir eI, Foil- &1v cA, 71) -1/yt; VP
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
. Address of authorized person (number and street,city,state,and ZIP code)