HomeMy WebLinkAboutMortgage_Odom 4. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION am.
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State Form 93709(R11/6-09)
Prescribed by Department of Local Government Finance t
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INSTRUCTIONS: ∎Ta .
Form filed wu: my.
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Fling Dates: 1) Real Property:Must file during the year for which the deduction is sought , Auditor
2)Mobile/Manufactured Homes not assessed as Real Property!Must file during the twelve(12)months EP / C U I¢
before March 31 of each year the deduction is sought County Recorder
See re side for additional instructions and qualifications_
owner or contras uyrer-see on reverse Ede) GIBSON CO TY
Qom, td 6pth D ye, AUDITOR
Taxing District Key n unbar/ d • than Record numt Page number
Flo - 1 -1 -/i - /Co - 001. ) 77 - 0 a.( do 3 A7Si
Assessed U real as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
March L tyear Mardi t,current year data of applca5�yn legal or equitable owner?
If no,what is his I her exact share of interest? If owned with someone
/WOO indicate with whom ❑ Yes ❑ No
If name on record's different than that of applicant,Indicate below I Is the property in question:Annually Assessed
fl Rost Frooer v fl Am-9 _-_.. _
Name of mortgagee or contract r • A- �r / ///''���
Address of mortgagee or contact seller(number and sweet, • fe,and ZIP code)`/'/ cO I S. 1`/ e /
Name of assignee or other owner or holder of mortgage l VVV^UCC(/ -I{—�--(/
Address'assignee(number and street,Uly,state,and ZIP code) I 57f
T tit ) 1 ! - 3 -l 1- 6,.53 A G
Does county in Indiana lo any other If yes.what county? What Taxing Di CO (�/)M 1 I
❑ yes ❑ No ' r 11 '11\�,,,�/-�f-uy tid
COUNTY AUDITOR 3 1 - t_
Deduction approved in the amount of
20 20 20 20 ��///O�/'� If-��' .4` C q--0778 TO T/ T
Signalize of County Audi:oi County 1 1�1../�, / ait�.(J/1/y `jr(1 `/
I I We certify certify u penalty of perjury that the above and foregoing Information is true and correct and that the applicant is a resident of Indiana and
owner/co ct buyer of the aforementioned property on date application is filed. .
)/SC (o ea MI name) ^ Date(month,day.year)
!� 1 _ /N/
K Full msid t address o (number and street, te,and ZIP code) J,f
.571.0 5 o Lc) �� Lot 4.76,47.1—
Person authorized 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)