HomeMy WebLinkAboutMortgage_Cantwell 4� . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I county l Township I Year
t!, FOR DEDUCTION FROM ASSESSED VALUATION {lg��LE
Picots Form 437O9 rum/6-09)
ptate for by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. 4 R1 U U artn
2er/014
Fling Dates: I) Real Property Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months �er
before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. GIBSON COIIAITv
Ayer t(owner or contract buyer-see on reverse side) .r1UDITOt2
1
T Oistrici ben/legal 'peon Recant number Page numbs
�dlo ° � — a5 - ohs - oo 130 017 I 'I 3105
Assessed valued property as of Mortgage/Conrad indebtedness unpaid as of Mortgage/Crn•,ract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current March 1,cement year date of application legal or equitable owner?
/96 000 ❑ yes ❑ No
If no,what 6 his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annuaily Assessed
i� Mobile Home(IC 61.1-7)
Name d mortgagee or contract seller /� -////ems` ,'`''
Address of mortgagee or contras seller(number and street city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage I-—.
C'Aui Wa •D/Wes ta1C
Address of assignee(number and street city,stale,and ZIP code)
Jfc3UEI-ore S
Does applicant own property in any other I If yes,what county? What Taring District? �j .�
county in Indiana? El Yes ❑ No • /q-.Luz
COUNTY AUDITOR
Deduction approved in the amount at
20 20 20_ 20 20 20 20
y9caC " County Data(month,day,yea0
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.
r
(owner's
( Date(month,day,year)
Ve ress of appthont(number and street a1J:slate.and ZIP code/4,414e
8 E amity; 4,✓�l Pd /N g7>0 �/0
Person authored by duly exean:ed Power of Attorney or by td 6-1.1-12-0.7 Date(month,day,}ear) I.
Address of euloRed person (number and street afy,state,and ZIP code) .