Mortgage_Buchannan a_ : STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNES raj+,■ It Township Year
FOR DEDUCTION FROM ASSESSED VALUATION !;,/
State farm 43709 Department/6-09) F .. —_ -
Presmbed by Department of Local Government Finance
INSTRUCTIONS: SEP 1 9 z0¼ File Mark •
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located Finn ed with:
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. nr - unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Re during the twefvel - , tre l R ty
before March 31 of each year the deduction is sought COUNTY A JD Court Recorder
See reverse side for additional instructions and qualifications. GIBBON
Applicant 6,wn*or contact buyer-see on terse side)
.OJn Jan _ii, 1 9f 01 /Y2./Z /mil /
T g Key number/legal description Record number Page number
97�is -0-7- 'if0/0007U - 1 dc2 / .37, 0"
evn vt value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appacant the sole
March 1;amnt sear Mardi 1,=rent year date of application dal or equitable owner?
oO ❑ Yes ❑ No
If rho,what is this/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
l Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee erntrad seller
Address of mortga or contra r(number and street,city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,ctrl,state,and LP code) ��_`` �//_---
Does applicant own property in any other If yes,what county? • Mat oV(• u a d Y Ad h h property
county in Indiana?
❑ yes ❑ No qq ID No
COUNTY AUDI' /� 7J '
Deduction approved in the amount oft •
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 I contract buyer of the aforementioned property on date application is filed. .
Sl\/gn^�aDUm( h full name) ,/ Date(month,day,year)
Full resident address of applicant�t•(Jnumberand state, LP code
X 7 7 0 f° 9e> P - /7 ).70
Person authorized by duty 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 LP code) -