HomeMy WebLinkAboutMortgage_Johnson (27) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.e; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Deportment of load Government Finance
F F T I)
dew' I
INSTRUCTIONS:
Form Red with:
To be fled in person or by mail with the CountyAuditor or County Recorder of the county where the property is located. Or4�-T�t n (��,1
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought LJ 2 jo12tq'rfltditor
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 - n El County
See reverse side for additional instructions and qualifications. ).10
Ap t(ownerorntt
mbuyer a on reverse i '9 � GIBSON l-UU9lY AUDITOR
Taxing District Y!` number/legal description / Record number Page number
`/ A & -i8- a7- °3 -000. y&9 -a .t .1- 14 LilS2
Assessed vale teal property as of Mortgage/Canna indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the apprmnt the sole
March 1:anent year Martin 1,current year date of wer�e:a.q0o_n-� legal or equitable owner?
11.owned L,a ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other n space,I dicate with whom
If name on record is different than that of applicant,indicate below Is the properly in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Motile Home(IC R-1,1-7)
Name of mortgagee or contract seller C /3 ,`��
Address of mortgagee or contract seller(number and(`/tree1,cdy,stare.and VP code) ,O I4I y
/ AN utt 1.---
_
Name of assignee or other owner a holder of mortgage 1/ /1 'I
Address of assignee(number and street,dry,state,and LP code) 1 L{"4/50
Does applicant own property in any other If yes,what county? - What Taxing Disbi
county in Indiana?
❑ yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount at
20 20 X20` l 20 20 20_ 20_
•
Sigruaae t () County Date(month,day,year)
I/We certify under the penalty of perjury that and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner!,'contract buyer of a aforementioned property on date application is filed.
y Sigma r r (r}d hers full i s Date(month,day,year)
'\ /[ttl-•.'�of applicant(number and street,a1):state,and ZIP rode)
yGSFG,, :re•itkc-F, i 4DeifsUi/k ,TAU YrOuc
Person authorized by duty exewted Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,rdy,state,and ZIP code). .