HomeMy WebLinkAboutMortgage_Dupps (4) �, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
•Presmbed by Department of tad Government Finance I 1 -ate
Fr:�a ) ti)1 Jill 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. ���vrp��
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. ❑ IY3ludtat0 f4
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months 1
before March 31 of each year the deduction is sought - ❑ County Recorder
See revue side for additional instructions and qua!'.-tions. �� Y��'
L. rat::
GIBSON COUNTY AUDI OR
(� Record omnbel Page number
!r �� I .. ._. ��I � ,/_I , 0 l �{ 3373
zr.:_,•value of real propery as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract' .:. -. ess unpaid as of Is the applicant the sole
Marsh 1,current year March 1.omen year date of application O — _ ^ I legal or equitable owner?
(/°yXr.Jl ❑ Yes ❑ No
If no,what is his/her exact share of interest? I If owned with someone other than sp 'use,indicate with whom
If name on record S deferent than that of applicant.indicate below: Is the perty in question:Annually Assessed
�I dal amparty ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Z...edigaA IP Ili %
Address of mortgagee or contract seller(number and street.city,sta and LP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sweet,city,state,and ZIP code) a / e a�� // /) /�� 2 .
Does applicant own properly in any other If yes,what county? (J/�"What Taxing Disb t? Ha Has current deducton been requested on property .
aunty h Indera? ❑ Yes ❑ No _ ❑ Yes No
COUNTY AUDITOR
Deduction approved in the amount at
20_ 20 20 20 20_ nt•D 1:
If'CI .IY
Signature of County Auditor • County • •'• .
Card No. �� ` '•..
•
1/We certify under the penalty of perjury that the above and foregoing information is true and V
owner con..•• •• -r of the aforementioned property on date application is filed. I
i
1 r
al/assent..n._. . a t(nu ber and r.a state,and
Person authorized by duly executed Power 0 A�rney or by IC 6-1. -12-0.7 Date(modh,day.fear)
Address of authorized person (number and street city,state.end ZIP code) .