HomeMy WebLinkAboutMortgage_Dunning STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
ec
- State Form 43709(R11/6-09)
Presented by Department nent of La Government Panora N
File Mark
INSTRUCTIONS: I�I� I�I� q p 8
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is'ftJJAtedJ 1614' well:
Ring Dates: 1) Real Property Must file during the year for which the deduction is sought. 0 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(72) nths
before March 31 of each year the deduction is sought - _County Recorder
See reverse side for additional instructions and qualifications. G I BSO N COUNTY AUDITOR
Appfica caner pact payer-sel. /• on reverse side)
T r 9_ /v number/legal description Record Page number
a� - /A -it —. 'LOA OoO . 1 y a28 r3x ( 5
1 Assessed value of properly as of Mortgage/Contra=indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of is the appfl ant the sole
Mardi 7,annul[year March 1,current year date of appOcation legal or equitable Amer!
1 �1 00 �, 0 Yes ❑ No
If no,what is his/her exact share of interest? if owned with someone other than spouse,indicate with whom
If name on record is(Efferent than that of applicant.indicate below Is the property in question:Mnually Assessed
❑Real Property ❑Al AnnuallyAssessed 1.1-7)
Name of mortgagee or contract seller Q A..t.41 n _ — ____ _l_
Address of mortgagee or contract seller(number and street,ci t•state,and ZIP code) D u N U rr(J Gr ;J(,rj ff 4 4 C—
Name of assignee or other owner or holder of moor_,age ��30115 IT 0"
Address of assignee(number and smee4 oily,state,and ZIP rode) I : --
. 55 a.a-e - 349
Does applicant own property in any other If yes,what county? What Taxing District?
county in Indiana?
❑ Yes ❑ No I tJ yes IJ No i•
COUNTY AUDITOR -
Deduction approved in the amount of:
20 20 20_ 20 20_ 20 20
Signature Co N Auditor • d{/$5� County Date(month,day,year)
We certify under the penalty perjury that the above and foregoing information is true and correct and that the applicant S a resident of Indiana and
owner I contract buye of the aforementioned property on date application is filed.
,cc, h na er's M rte
iesid enttaddress of a pplrant(num gret.ray,state,and ZIP bodit, Date(month,day,year)
X
S. S-for-now1L ACC-1-on--4 j_..,47, 4176 70
Person authored 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 dry,state,and LP code) •