HomeMy WebLinkAboutMortgage_Enyeart 4!. STATEMENT OF MORTGAGE OR CONTRACT INDEEIrliti D Township Year
b;,1,;' FOR DEDUCTION FROM ASSESSED VALUATIONi
sh„�. State Fonn 43709(R11/6-09) /
Prescribed by Department of Local Government Finance
INSTRUCTIONS: S E P 18 2014 File Mark
b be filed in person or by mail with the County Auditor or County Recorder of the county where the mperty is located. Form mail with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. `hL, County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during Hr� ' - $L rhs �urrty Recorder
before March 31 of each year the deducffonssought GIBSON COUNTY AUDITOR _
See reverse side for additional instructions and qualifications.
Apprs�pt(or contract buyer-see on reverse side)
C /
/legal d Record number Page number
i 2.10- /a -o7 - z ? 6-0a 2.09.6 /( S'3
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appricant the sole
Mardi 1;anent year March 1,current year date of application legal or equitable owner?
y ne,8-6p • Dyes ❑ No
If no,what Is 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 ❑Annually Assessed
• Mobile Horne(IC 6-1.1-7)
Name ofee or mntraa}Q9er _ y n il
Addmss of mortgagee or contract suer(number and sheet,city,state,aria fJP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,cry,state,and ZIP code)
Does applicant own property in any other If yes,what county? : ------ I on property
manly in Indiana? �j
❑ Yes ❑ No (�� s ❑ No
Drawer NO
Deduction approved in the amount of: //r, :
Card NO. ..../.4 111.>�1111
20 20 20 20_ 20 _
I I I
Signature of County Auditor • County Date(month,day,year)
I 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/contract buyer of the aforementioned property on date application is filed.
`Signature(o (u0 rh�rtnBL Date(month,day,year)
/V �.C//7 -d1
Full address of applicant(nu- .. - •street oo�,state,end ZIP code)
'r 5-017 c lira , w ]]
cZ / -is ce a// Zit/ 4'76 70
Person authorized by duty executed Paira 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) .