HomeMy WebLinkAboutMortgage_Muckerheide STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS��eou TOWnship Year
tFOR DEDUCTION FROM ASSESSED VALUATION F 11 {���-J{IJ q Y
-_ _ t- State Form 43709(R11/609) ��..//
fhescnbed by Department of Local Government Finance
SE? 11 2014 File Mark
INSTRUCTIONS: Form filed with:
M be filed in person or by mail with the Cowry Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought -tit ZI County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the 1 -wy.fiyF r
See reverse side for dditional instructions and qualifications. sought GIBSON COUNTY AUDI�O� County Recorder
r-er M!cza buyer-ae�ert irons on reverse side), _
Tadrgj.7'strict Key
CO number o✓G Z 5-30o w / . Co 7 D cc-V Record I l Pag�`pte`✓ b
Assessed value afreall property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,arrest year Mash 1,anent year data of application legal or equitable owner?
33a0OC.) El Yes El No
If no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name on record is dGierent than that of app&ant,indicate below: Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Nam/ey�a{f mortgagee or contract seller
Address of mortgagee or contract seller(number and street,gay,state,and ZIP code)
Name of assignee or other owner or holder1Y----J,:_i __.�,_:.____....:........•
Address of assignee(number and street ray. ,���.f(�
Drawer NO... ••
Does applicant own property in any other /�. :. Has this deduction been requested on property
county in Indiana? ❑ Yes C for arrest year? •
❑ Yes 0 No
Card NO.
Deduction approved in the amount of
20 20 - 20_ 20 20 20 20 .
Signature of County Auditor ii. County Data(month,day,year)
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/contact buyer of the aforementioned property on date application is filed.
5gnatun Date(month.day,year)
Fu➢ nt ad of a t(mum rand sheet.icily,state,and ZIP code)
authored by duly executed Power of Attorney or by IC 61.1-1241.7 Date(month,day,year)
Address of authorized person (number and street,city,state,end ZIP code) .