HomeMy WebLinkAboutMortgage_Pearson STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
ra ;, FOR DEDUCTION FROM ASSESSED VALUATION
;i`' f State Form 43709(R1116-09)
Pr so hed by Department of Local Government Finance ..
:File i., .`
INSTRUCTIONS: Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought J L ity Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly Must!fie during the twelve(12)months County Recorder
before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Pilitt
Applicant buyer- GIBSON COUNTY AUDITOR
nt owrrerwrcontrect b r see m reverse side
T Key / I desaiptim Read number Page number
a6 - OS- yo - /D9 - 0 0 0 . 3611 -o . ? / 99 9 2,5-7 6
value of real as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,wren year March 1,current year date of application legal or equitable Amer?
3a000 ❑ Yes ❑ No
If no,what is his I her exact share of interest? if owned with someone other than spouse,Indicate with wtrdn
If name on record is different than that of applicant.indicate below Is the property in Question Annually Assessed
❑Real Property ❑Annually Assessed
Montle Home 0C 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and city,state,and ZIP code) DI- }} i q
el- 1\o....1.9?�
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street miry,state,and LP code) C7--6..... 2
Does applicant own property in any other If yes,what county? , I What Taxing District?
county in Indiana? tor w,._.. _
❑ Yes ❑ No
COUNTY AUDITOR -
Dedudion approved In the amount of .
20 20 20 20 20 20 20
Signature of County Auditor • County Date(month,day,year)
I 1 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 huff name) Date(month,day,year)
iFull resident address of applicant(number and street,oily,state.and ZIP code)
a lac 4. SrA<E C'cal 65 P7:2,tck-r\ .`-1-C • 47"
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,stale,and ZIP code) •