HomeMy WebLinkAboutMortgage_Ott (2) a. a _ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cow _. To Year
f- FOR DEDUCTION FROM ASSESSED VALUATION F' I
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' � State Fonn 43709(R11/6-09)
Prescribed by Departmerd of Loral Government Finance
INS7RUCifONS:
OCT
File 6 014
To be filed in person or marl with the Coun Auditor or County Recorder of the county where the property Form
Pe by ry h ty p pertyklocafed. ❑
Fling Dates: 1) Real Property:Must file during the year for which the deduction is sought � dry�dl(or
2)Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months ,l �
before March 31 of each year the deduction is sought - Nr Recorder
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See reverse side for additional instructions and qualifications. G I B SO N COUNTY AUDITOR
App&ant(owner or contract buyer-see restrictions on reverse side) / ,
C'eC/nX (� rTZC � ian c/e to , GC/�J�LeQit�¢
Taxing Distict Key number/legal descriptbn mber u 1� Record nu Page number
a6-) 7 - 0A - Liao -00 y. 8S6 - pa PI Nagy /
Assessed of real as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
March 1;
year March 1,anent year data of application ''A S/ legal or equitable owner?
�q,[ _bOOU ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other ihannsspCouuse,,IIndicate with whom
If name on record is different than that of applicant indicate below. Is the property in question:Annually Assessed
❑Real Property ❑AnrluallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 5' 3
Address of mortgagee or contract seller(number and street city,state,and ZIP code) 4� 0 r l ('j t T�
VI ' ( t-r `
Name of assignee or other owner or holder of mortgage v I
WWnny, L Au et--1)
Address of assignee(number and street city,state,and ZIP code) 1 q_Lai
Does applicant can property in any other If yes,what county? • What Taxing Dsbict? _ _
county in Indiana? ❑ No I for aneni YeaR ❑ Yes
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the arnount oft •
20 20 ��� 2 0-� 20 20 20 20
Signature of County
17Y—/xa.v County Date(month,day,lead
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. .
6 hill name) Date(runts day.yeti
�7.v CS/�ifjf)/
X Full resident address of applicant(number and street aiy,state,and ZIP code)
—1500 (46.1-vei (_tUU ()wensv\\ ile 1 NJ Lilco (nS
Person authorized by dray executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and steel city state,and ZIP code)