HomeMy WebLinkAboutMortgage_Knowles (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year ii.)
I.; ;' FOR DEDUCTION FROM ASSESSED VALUATION g
°2t: State Form 03709(R11/6-09) ay
Presaibed by Department of Local Government Finance
File Mark •
INSTRUCTIONS: Forth Oed 11JL 70 VI
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. wCltl 8 U C
Poling Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ only Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months y'y" ^p� M,((d�
before March 31 of each year the deduction is sought - ❑
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUU TOR
Apprrcant(• o,�ntra�r buyer-see `on nave e)
AM-'Li i- O1- i/, a k741 /1 'axing •C,4. ICeY number/legal descrip' // Record number/ Pa e, Aber
Assessed .•••of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mach 1 •- •.,year March 1,current year date of aeration� legal or stable O
((LL// yes No
If no,what's his/her exact share of interest'? If owned with someone other than spouse,indicate with whom
If name on record's different than that of appkanL indicate below Is the property in question:Annually Assessed
❑Real Properly ❑Annually Assessed
Mobile Home(1C 6-1.1-7)
Name of mortgagee or contact seller '-�-,/19
Address of mortgagee or contract seller(number and street.city.stare.and ZIP codL e
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 If yes,what county? • What Taxing nictrint9—_—_ I u.....44..r."__.___—_._ —_—',
county in Indiana? Ct n I A r) A. K i, ein i No
❑ Yes ❑ No dam" `'^ I o�(/�//'L7/
COUNTY AUDITOR Drawer NO..,2/Y.f.J........
Deduction approved in the amount of: l�. T.
20 20 20 20 Card NO.
C28oY .,/1
Signature of County Auditor • Canty 4 95,000.W
1
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.
Signature(owner's roll name) Date(month,day,year)
Furl resident address of applicant(number and street.city,state,and ZIP case)
X
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 andstreet,city,state,and ZIP code) .