HomeMy WebLinkAboutMortgage_Taborn STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
�f-'"sr j State fvrtn 43709(Rut/6-09)
`�.L'^'f Prescribed by Department of local Government France
F ile
INSTRUCTIONS: Form filed with:
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. �n!1 ff AA�
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought AUG 0 tL I J Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications. & • •
Applicant(owner tram buyer-see restrictions on rex e) A GIBSON COUNTY AUDITOR
T District Key number/legal desaip llr✓L•7/lvnr•••` Record Page n
t Q - ► it-I g- 3°o3- ouo •QCI I -do? 4O/ ' 30163
Assessed vela real property as of Mortgagge!Contrail indebtedness unpaid as of Mortgage!Cwraar3 indebtedness unpaid as of Is the app&ant the sale
Mardi 1, Marts 1,rarrtent year date of aPP�ca(l� lalal or equitable awns/?
(J7 r ❑ Yes ❑ No
If no,what is his!her exact share of interest? I It owned with someone other than spouse,Indicate with whom
If name on record S different than that of appLicant Indicate below Is the property in question:Annually Assessed
Ii ❑Real Property ❑Mobile IN 6-1.1-7)
Name of mortgagee c contract seller , r� /(
Address of mortgagee or contract seller(number/-`annd(stet,city,Sinte...and ZIP code)
Name of assignee or other owner or holder of mom-rage
Address of assignee(number and street,city state,and ZIP code) ___ __- - _. _
Does applicant own property in any other If yes,what county? What Ta
county in Indian?
❑ Yes ❑ No I Drawer NO C9Q/ No
COUNTY AUDITC -
Deducaon approved In the amount at Card NO. 3
20 20 I 20 20 Q C 9JUQ. &w Oy)n
— -
I I I
Signame of County Auditor County Date(month,day,year)
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 data application is filed.
owner's MI me) I Date(month,day.Year)
V � _
pp (numbs acct stre et crry,state,and Lp cotle)
1-115 NJ ( alias 12V�*) .�►- 4 Z cc, a
Person authorized by duly executed Power of Attorney or by IC 6-1.1- -03 Date(month,day,year)
Address of authorized person (number and street city state,and ZIP code)