HomeMy WebLinkAboutMortgage_Leeds €. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'' FFOR DEDUCTION FROM ASSESSED VALUAAAri F
State Form 43709(R111 6-09)
1 T
Prescribed by Department of Load Government Finance a, I
File Mark
INSTRUCTIONS: FFpp 99 QQ ,,tn�'',1
To be bled in person or by mad with the County Auditor or County Recorder of the county elJeNterprooj4erty is located. Form filed wilt
Firing Dates: 1) Real Property Must file during the year for which the deduction is sought County Auditor
2) Mob,le/Manufactured Homes not assessed as Real Property:Must during a tw 12.months
before March 31 of each year the deduction is sought County Recorder
See reverse ' for additfYionaal ll}�instnralonsa'and qualificatiii0000'���n(s./�[/��J/�� G)BSON COUNTY AUDITOR
Taxing [strict '�'man ' _� g-&oo-ooi. 06,67902.5- R 001 P�(o S 8.2
Assessed value of real property as of Mortgage r Contract indebtedness unpaid as of .Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1:anent year March 1,at �L{�9��' ^ data of application legal or equitable owner?
• ❑ Yes ❑ No
If no,what Is his l her exact share of interest? / If owned with someone other than spouse,Indicate with whom
If name on record is drferent than that of appficant indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually A
• Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller 0-11
Address of mortgagee or contract seller(number and street cwt state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any other If yes,what county? . What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ No for current year?
❑ Yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction a ea in the amount of. _
62/40 4 _ CdO0
20 P mOl 4n �"� 20 20 20 20
�raweicNo.a0.7
Signature a �,o County Date(month,day,year)
I/We c Card NO. t 5gQ )ping information is true and correct and that the applicant is a resident of Indiana and
owner I phcation is fled.
v. .y /. -fup/.: Date(month,day,year) --
tin resident address. a t(number and t CRY:state, ZIP )
E .1.1 v VO /6 ',I dy /4/ 1f76 VI' •
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 ray,state,and ZIP code)