HomeMy WebLinkAboutMortgage_Mayer (3) O STATEMENT OF MORTGAGE OR CONTRACT IND SS my Township Year
FOR DEDUCTION FROM ASSESSED VALUATION F State Form 43709(R1116-09)
Prescribed by Department of Lod Government Finance
File Mark
INSTRUCTIONS: S E P 3 2014
Form filed with(
To be filed in person or by mail with the County Auditor or County Recorder of the courtly where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought Er...County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Re du' 4 nths
before March 31 of each year the deduction is sought ✓ ❑ County Recorder
GIBSON COUNTY AUDITOR
See reve �� a for additional instructions and qualifications.
Appfcant.9 or contract buyerys�e res 'tiuns on reve site) ��)/��/y//'/�/0
T : • District h/•//tn�� U Key be I desrn� —3o'O^ �. �� Record number Page number
{/ 14 3-3D
Assessed vahne of real property as of Mortgage/Contract indebtedness unpaid as of Mort gage/Contract indebtedness unpaid as of Is the applicant the sole
March 1, t year March 1,current year date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her end share of interest? If owned with someone other than spouse,indicate with whom
If name on resod is afferent than that of applicant,indicate below Is the property in question Annually Assessed
❑Real Property ❑Ann
Mobile Home C ually Assessed 1.1-7)
Name of mortgagee a r/) .
Address of mortgagee or contract seller(number and �L `itcy-3/Ctstate,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,cay.state,and ZIP code)
Does applicant own property in any other I If yes,what county? I What Taxing District? Has this deduction been requested on property .
oounry in Indiana? ❑ Yes ❑ No
fur year ❑ Yes ❑ No
COUNTY AUDITOR I-
Deduction approved in the amount of
20 20 20 20 20 20 20
Sig "i:of County A 'tor ii County Date(month,day,year)
' n 1
I 1 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.
.h hit name) MM tt��PPww Date(month,day,year)
t address of applicant(numberaAndsbee4 ay,state,and LP code)
O 90 (Dto C . aDS 1N. FDA ecc\ y 1 I 47to ye(
authored by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(ninth,day,year)
Address of authorized person (number and street,aty,state,and ZIP code) .