HomeMy WebLinkAboutMortgage_Huff (6) F:a. .- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State form 93709(R11/6-09)
Prescribed by Department of Loral Government Finance
INSTRUCTIONS: TL /
Farm Ned with:
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. ((�l(�T 3 �f R County Auditor
2)Mobile/Manufactured Homes not a resed as Real Property:Must file during the twelve(12)months 3 C
before March 31 of each year the deductions sought - County Recorder
See reverse side for additional instructions and qualifications.
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/ ,. \ GIBSON COUNTY AUDITOR
I!� Key number/legal description Record number Page number
, a(c) - 1 ).-18 — / 0/ — 000. 972 -0 .- 8 goof 3987
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1:cumin year March 1,current year date of applmtni �y legal a equitable owner?
5
If no,what is his/her exact share of interest? If owned with someone other than spouse, ❑ Yes ❑ No
indicate with whom
If name on record is different than that of applicants indite below: Is the property in question:Annuafly Assessed
❑Real Property ❑AnnualyAssessed
• Motile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract setter(number and street,city,slam.and ZIP code)
Name of assignee or other owner or holder of mortgage
Addresp assignee(number and seer,state,and ZIP code)
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Does applicant own property in any other If yes,whet county? • What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
Yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Sig/n�atuure of Coanty,Aruditor County Date(month,day,year)
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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. .
Signature(owner's hA ryme) r Date(month,day,year)
/ Full resident of applicant(n and store;a115 state,and ZIP code)
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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 sheet,city,state,and ZIP code) .