HomeMy WebLinkAboutMortgage_Lankford s._ . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
LeState Fong 43709(R11/6-09)
Prescribed by Department of Local Government Finance
tie Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property isbeatel(,14 Form reed with:
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. V L U County Auditor
2)Mobile/Manufactured Homes not accessed as Real Property.Must file during the tweNe(12)months County Recorder
before March 31 of each year the deduction is sought - my
See reverse side for additional instructions and qualifications. GIBSON n
(owner or wria . buyer- iesbic:ons on s e) - "'^' T AUDITOR
Drs: number/legal description Record number Page number
aTw I3toaoo /4 4ti7 7
Assessed value of real as of Mortgage cu/Contrail indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appfrant the sole
March 1:and year March 1,wrtent year date of application legal or equitable owne?
10- 1 Q. - 1 5— d60 — 003- -7ti S.- 0-2: -7 El Yes El No
if no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is dffennt than that of apptiant,indicate below. Is the property in question:Annually Assessed
Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mote or y g...-lT l
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage - nnIhl _ -
Address of assignee(number and street,city,state,and ZIP code) (wllUj `-" "t. /1 _ -
Does applicant own property in any other If yes,what county? • What Taxing Dist • � r--(• —
county in Indiana? ❑ Yes
❑ No �
COUNTY AUDITOR l ql I/�`f f/'7
7
Deduction approved in the amount of
`
20 20 20 20 20 I 2U
Signature of County Auditor • County Date(month,day,year)
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(o yrne Date(nnirh,day,year)
10 / lob a07/7 F W t(num and street,a1y,state,and ZIP code)
P 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 street,city state,and ZIP code)