HomeMy WebLinkAboutMortgage_Young (19) STATEMENT OF MORTGAGE OR CONTRACT IN -: Township Year
pps FOR DEDUCTION FROM ASSESSED VALUATIO J .' fit
State Form 43709(R11/6-09)
Presaibed by Department of Local Government Runs
INSTRUCTIONS:
Form 2 1 2014 File Mark
INSTRUCINSTRUCTIONS:
Form Ned with:
-b be filed in person or by mail with the County Auditor or County Recorder of the county where the prope I is y.. - •.
Filing Dates: 1) Real Property Must Me during the year for which the deduction is sought .V NI County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must filed ' • t•: • e�fiOR
before March 31 of each year the deduction is sought GIBSON COON ❑ County Reorder
See reverse side for additional instructions and qualifications.
AppficiTher or 9<er see restrictions on reverse Side)
Taxing District Keyumber/legal description Record number Page number
-fib-I9 -isr-� I/ C4X2 8ya -oas- dopy X978'
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sale
Meru 1,current year March 1 ie t}mar date of application legal or equitable owner?
r ooO El yes ❑ No
If no,what a his/her exact share of interest? If wined with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below. ,sethee property in question:Annually Assessed
1 :teal Property El s
ArmuallyAsseed
7 Mobile Home(IC 6-1.1-7)
•
Name o! ortgagee or contract seller �/,,,11,'/
Address mortgagee or�seller(number and and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city:state,and ZIP code) (' ,,�,, Q�
Does applicant oven property in any other Ill yes,what county? Pr 1 wu-t.L th -earl luested on property
county in Indiana? ❑ Yes ❑ No ] Yes ❑ No
Drawer NO 4011/ .
C
Deduction approved in the amount of
Card NO. }�a9']8yyyy , i
20 20 20 itIg/000• / -
20
Signature of County Auditor County r 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 date application is filed.
I, r Date(month,day.year)
Full resident address of applicant( umber street arty,state ZIQ code)
X 7„2O s , �.-I- 7 a 1- z; - tzz7‘ 7„)'
Person authorized by duty executed Power of Attorney or by IC 6-1.1-1?-0-7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .