HomeMy WebLinkAboutMortgage_Froemming a. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
" FOR DEDUCTION FROM ASSESSED VALUATION
.,5• State Form 43709(R11/6O9)
Prescribed by Department of local Government Finance —
INSTRUCTIONS: 'Ma
be filed in person or by marl with the CountyAuditor or County Recorder of the county where the property is located. ram ,r: T
To
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought f my Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months A L 2 U I q
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications. ..
aopux nt�owner or cos-tact buyer-see eC c0os on reverse side)
07"
y/ Q/ yln af � GIBSON COUNTY AUDITOR
Taxing 0' ' la (0 . /3- /9 300 - co/. 736.- oo y 2oi'.l P�3396'
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sale
Manic 1,anent year Mardi 1,=rent year date of application legal or equitable owner?
// _7 ay y ❑ Yes III No
If no,what is his/her exact sham of interest? I If owned with someone other than spouse,indicate with whom
If name on record is diferent than that of applicant induate below: Is the property in question Annually Assessed
❑Real any ❑Mobile Home Mobile Home QC 6-1.1-7)
Name of mortgagee se4er • 7� �j�t� ('__/I
Address of mortgagee or contract er(number and ray,state,and LP ''e D 1.2\Te 1- NO `S/ /
Name of assignee or other owner or holder of mortgage �j/'1
Card NO. 5F --Address o ee(number and street,city,stare,and ZIP code)
'usu.) 2 - 9 1. 11 7
Does applicant own property in any other If yes,what county? What Taring Ds,
aunty in Indiana? ❑ Yes ❑ No Mr anent yearr
I ❑ Yes ❑ No I-
r
COUNTY AUDITOR
Deduction approved in the annum of.
20 20 20 20 20 20 20 .
Sigrrabue of Conti Auditor . County Date(month,day,year)
I 1 We ce penalty of perju 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.
\1 Slg (owner !y(tl//r/name), /s r (� (� Date(month,day,year)
Ir / /addrev W ay-{G p !n/�berprs/� = t1tep �� 1 ri/- Ig
Person authorized by duly executed Power of GAttom't Attorney or by IC 6-1.1-12-0.7 (� Data(mouth,day,year)
Address of authortmd person (number and street city,state,and ZIP code) .