HomeMy WebLinkAboutMortgage_Dunigan STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r�� FOR DEDUCTION FROM ASSESSED VALUATION F I u. - State Form 43709(Rh /6-09)
� Prescribed try Departrrrem of Loral Government FinanIlk
INSTRUCTIONS: o
To Flan 0 be filed in person or by mail with the County or County Recorder of the county where the property is located.AU I C u IY:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/Manufactured biomes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - , a -e°^' -ecorder
See reverse side for additional instructions and qualifications. G I BSO N COUNTY AUDITOR
Applicaanntt(owner
or contract buyer-see restrictions
1� g 0i rest iclirnu verse tide) � ∎
K
l
axinstric[ legal d Record number Page number
/it —/9-/8- -303 - 000, 474 - el AL IL! I S y I
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 I,current year March 1,anent year data of application legal or equitable owner?
6 0 0 0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? I ff owned with someone o than spouse,indicate with whom
If name on record is different than that of applicant,indicate below. - Is the property in question:Annually Assessed
El Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
Address of mortgagee or contract seller(number and street,city,staz,and ZIP code)
Name of assignee or other owner or holder of mortgage _ ' /( -
Address of assignee(number and street oily state,and ZIP code) I L — I8// /
Does applicant own property in any other I If yes,what county? What Toxin! tit .�y�/ �1' )I
county in Indiana? ,D(JY)I P�a1)1 S 1 �,y �i^� No
❑ Yes ❑ No J ' k,qxcr4
COUNTY AUDITOR
-
Deducton approved in the amount at.
20 20 20_ 20 20 20 20
SigrsWre ate/ Cohmry AWiwr, /; i Caunry Date(rtorW,day,year)
6AFi/h4.-- ---&- .,
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.
( rss n4l err e) Date(monIh,daY.year)
Full rr� address of�of//appG (number and era city,state,and ZIP code) //o
A ,SOa E. c!(ranr7 PI OfanG4 //1/ V7‘92?
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 and street city,state,and ZIP code)