HomeMy WebLinkAboutMortgage_Hasenour (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS __LI) Year
mg,.:. a �
: FOR DEDUCTION FROM ASSESSED VALUATION
State Form 03709 /6-09)
Prescribed by Department(R11/
of Local Govemmera Finance
File Mark
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INSTRUCTIONS: OCT 7 .
Fonts
To be filed in person or by mad 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. /� �r County Auditor
2)Mobile/Manufactured Homes not assessed as Real Properly:Must Re during the twelve(12)mootfr,Y • F Y�
before March 31 of each year the deductions sought - N� W. County Recorder
GIBSON COUW" AI InrTOR
See reverse side for additional instructions and qualifications.
Appfcant(owner ormrbadd buyer-s^ee' onre rattle)�f
ie T District w ` T legal ptonl� Record number Page number Key number/
(}}p�J-� Aco - ,7 �- /.Z - 300 - oo .i.. Ctloa - oaA /(d Li tL{�
. value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mash 1:and year Mardi 1,current year data of app&Cation legal or equitable owner?
01 9a - 0 0 0 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with sorneone other than'spoise,Indicate with whom
If name on record is different than that of applicant,Indicate below Is the property in question:AnnualyAssessed
❑Real Property ❑Annually Assessed
• .(2') �,�/�J�
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 1 �r &. ,v " "
Address of mortgagee or contract seller(number and Street,,ccity,smote,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) ——
[MS 04-/1
Does applicant own property in any other If yes,what county? • What Taxing Distil( ,ftyl pal/r' i3
county in Indiana? .1/�i �F/
❑ Yes ❑ No _ _
W-r ..S _
COUNTY AUDITOR
Deduction approved in the amount oh /Y—. q/r/r/T
20 20 _ 20 20 20 I 20 I c.,
y9na of County (month,day,
/
I 1 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.
naW�e(ovnets foil nnaaaJvee)r Date(month,day,year)
FW risident of applicant(number and Sbeet div state,and ZIP code)
A i/itO UJ /L0oS Ekicbsra.o(-( 1- g763Q
Person authorized by duty executed of Attorney or by IC 6-1.11-12-0.7 Date(month,day,year)
Address of authorized person (number and street.city,state,and ZIP code)