HomeMy WebLinkAboutMortgage_Chaplin STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County Township I Year
H. FOR DEDUCTION FROM ASSESSED VALUATION
T''t Prate Form 43709(Rm/bas) I I . 1 ark
Prescribed by 709(R Department of Local Government Finance
INSTRUCTIONS: Ira ad Fes]filed :
Filing Da filin ed Real Property Must file uring the year for which Recorder h deduction is sought the property hU U`l 9 2014 r-, county Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months 11----��
before March 31 of each year the deduction is sought. /), County Recorder
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See reverse side for additional instructions and qualifications. ,71�1Gt
Applicant( ryer or buyer-see restrictions on verse side) GIBSON COUNTY AUDI 10R
Gde Ci-- i f?'
i D' Key number/legal desaiptmn Record number Page number
A a 3 -040 - to/- 000. 66 9-00 9 / y 3 x93
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact Indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,omen year date of application legal or equitable owner?
159, DOD ❑ Yes 0 N
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 dfferent than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Horne QC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller and street,ci y.state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,dal,state,and ZIP code) -- -I. —–
Does applicant own property in any other If yes,what county? What Taring District? r /r pp IDL JV I oe m
county in Indara? ❑ Yes ❑ No I l: f'r t
591031 r_
COUNTY AUDITOR 1
Deduction approved in the amount of: I I`1—3 pI,9 3
20 20 20_ 20 20 ,
. 1
Sigrsture f County "_- �, County (rrmrh day:year)
,/6—
I 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/con. .. buyer of the aforementioned property on date application is filed.
" Sig -,..re • -h .1\I name) Date(month,day,year)
AFull sent-•: applicant(number and street,oTy,state.and ZIP code)
/� 40gi elfci Iyple. Nn-uhc'ccsr - - -N �� y -ico39
Person authorized by duty execute of Attorney or by IC 6-1.1-12-0.7 . Date(month,day,year)
Address of authored person (number and street.day.state,and ZIP code) .