HomeMy WebLinkAboutMortgage_Green •� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
-. FOR DEDUCTION FROM ASSESSED VALUATION
-sa. State Fans 43709(R11/6-09)
Pn�mbed by Departmerd of Local Government Finance pi
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. SE wltt.L u IQ
Filing Dates: I) Real Property:Must foe 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 in
before March 31 of each year the deductions sought - J!f �tyRemrder
See reverse side for additional instructions and qualifications. GIBSON Zr
a COUNTY AunITOR
Applicant(or er or contract buyer-see s 'ns on reverse
T ang Diana ,C.••C_/ -Key number da� Record number Page number
020 - ,-o_ 0 a you.3 -C3°a 07s_0 03 N 4o l0
Assessed value teal property as of Mort gage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applyant the sole
March 1,anent sear Mardi 1,anent year date of ap/o 7tion legal or equitable owned?
/ O v 0 v ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone t
wn her than spouse,indicate with whom
If name on record is afferent than that of applicant,indicate below:. - -- I s the property in question:Annually Assessed —
f_-.I{D.-..ro._--.. f1..`-r.._��
Name of mortgagee or contract seller �r I�, - _ i,12411-)
m ' ,c..c„s ,ear_ tits!lQp'1'l.
Address of mortgagee or contract seller(number and street,ray,5are,and ZIP code)
IL1' L{DID
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,rely,state,and ZIP code)
Does applicant own property in any other If yes,what county? . What Taring District? Has this deduction been requested at property
aunty in Indiana? ❑ No for current ye
❑ Yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of.
20 20 20 20 20 _ 20 20
Sigrahne olfty Auditor _Auditor _ County Date(month,day,year)
. i/We certify under the penalty o perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner 1 at ..a buyer of the mentioned property on date application is filed. .
Signature(. / .r :) L/ Date(month,day,year)
• 777JJJ 7///7//7 iii( /Full t of a t(num and street,D1y,stare,and code)
Person authoraed by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)