HomeMy WebLinkAboutMortgage_Edwards (5) ,.a . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
c.e.-.R
�„; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/609) I �'"�
Prescribed by Department of Loral Government Finance F B F, p
INSTRUCTIONS: IYI ONILa_rkJ. - -
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form met with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought U T ti (Bblltlty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications. I 171 -11 j,
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at or see restrictions.on reverse side) GIBSON COUNTY AUDITOR
i�4 R
Ta�•D' , • / Key rnlanha/legal description Record ben Page number
Alp -13 -/ _ /o/ . Do/• 921 -0 o `I 1`k 4319
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of 'Is the applicant the sole
Marts 1:anerrt year March 1,anent year date of application legal or equitable owner?
3?, 000 ❑ Yes ❑ No
If not what is his I her exact stare of interest? It owned with someone other t uwu spouse,indicate with whom
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Properly ❑AnnallyAsessed
• Mobile Home(jC 6-1.1-7)
Name of mortgagee or contract sell
�
Andres of mortgagee or contract seller(number and streel,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage '. `
Address o❑Oe¢//SJ (number street, Y's'ta�te},and ZIP code)//i./3 t/'� I
applicant property in any other If yes.wha(counfy? - What Taring t
county in Indiana. ❑ Yes y j'l�
❑ No /r .`1 7o
•
COUNTY AUDITOR CAOLJ"
Deduction approved in the amount of -
I`—I- 1439 —
20 20 . 20 20 _ --
Signature of County Audi County Date(north,day,year)
under///I 11W/ ti
We cerrtifyy `ndeer tithe penalty of perjury that the above and foregoing information is true and covert and that the applicant is a resident of Indiana and
owner ntra buyer of the mention property on date application is filed.
l _ Slgnaw von full re e Date(month,day,year)
X FW ant of a t aiy,
(nun r stria e state,and ZIP code
S 7 S a_ c a 5o d w cf'' v-7 (0 v- 7
P authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,dry,slate,and ZIP code) .