HomeMy WebLinkAboutMortgage_Doerner a. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Fc FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
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Prescribed by Department of Local Government Finance {{� �FEi twr
INSTRUCTIONS: I I F / - -- --
Form filed with:
RI be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought N Q V 6 2� County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must hie during the twelve(12)mon S
before March 31 of each year the deduction is sought - / ❑ County Recorder
See reverse side for additional instructions and qualifications. �i lrlton.
(owner or contact buyer-see restrk bns on reverse sae)
GIBSON COUNTY AUDITOR
. CL GP rra� Q� ,CQo �•�.,
Ta Thr�attrict Key number/legal description Record number Page number
`IilOrh.tu-e- 026 -e2/-3/ - _300 -000. 955 - o4)/ PP( 3Y9-5
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1:current year Mardi 1,current year date of application legal or equitable owner?
69, 0 0 0 ❑ Yes ❑ 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 different than that of applicant,Indicate below Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyPssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or con vaq setter
�1 I
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Add of assignee(number and street,city:state,and ZIP code)
- I T C Stu 3! - 3 -$ 5 . o A C-
•
Dees applicant own property in any other If yes,what county? • What Taxing 0-_, — I Has this deduction been requested on property
county in Indiana? ❑ No � � — CI.CI. v ❑ No
❑ yes _ ( y}Q,1 ,y� � ,, �////������_� ^` _
COUNTY AUDITOR etral 1�11I L-r...
Deduction approved in the amount of: - �C4L�rn- )_-e' a-
20 20 20 20 ,(�f
/U- N./q9-5
Sign.•-of County Auditor ` County
I/We certify under the pe atty of perjury that the above and foregoing information is true and correct anu u...._._ ,-
owner I contract buyer of the aforementioned property on date application is filed. ,
K Signature rs name) Date(month,day,year)
dr, �G. _L
r�Full resident 6115 applicant 1'(number
000 2 L city, U kiZIP n fir Gill ( r r. 1 41/01e0 Date(month,day,year)
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Person authorized by duly executed Power of Attorney or by 1IAC 6-1.1-112-0.7 U`'Y`I','t J-'V
Address of authorized person (number and street city,state,and ZIP code) •
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