HomeMy WebLinkAboutMortgage_Logestan �..f-a . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
LifState Form 43709(R11/609) A , j
Prescribed by Depaitnerd of Lod Government Rnance 1 (�.
r -r. a`r i)
INSTRUCTIONS: A�/y�n ed .
To be filed in person or by mad w i h the CountyAuditor or County Recorder of the county where the property is located. t o y
Ring Dates: 1) Real Property Must Me during the year for which the deduction is sought Gaily Auditor
2) Mobile/Manufactured Homes not assPcced as Real Property Must file during the twelve(12)months �
before March 31 of each year the deduction is sought - Y/�,,- ❑ County Recorder
See reverse side for additional instructions a ualifications. GIBSO f
Applicant oonuada 4� a.LL�Qi .c; mot/ CnUro�AUpl7'pR e)
T:•1 ,:� Keys /legal description/ , Record number Page number
J i Or-) �710-/.j .3Y /OD- �OOd. .%� �4 G/* /13
Assessed value d real property as of =ilea I Contract Indebtedness unpaid as of Mortgage l Conbad'indebtedness u as of Is the apprmant the sole
Mardi 1:sued year Mann 1.current year date of aP �'�,',7�„L� `/�`/ Iegal ar equitable a1.sw11
If no,what is his I her exact share of interest? If owned with someone osier than spouse,indicate wvh wham ❑ Yes ❑ No
If name on record is deferent than that of applicant Indicate below: Is property in question:Annually Assessed
Real Property ❑Mrivally Assessed
6inexo //�J Motile Home(IC 6-1.1-7)
Name d mortgagee or contract se9er d, i / �r������Address of mortgagee or contract seller(number and street city,ste code)
Name of assignee or other owner or holder of mortgage , / (f–/) / 0017_ 9
Address of assignee(number and street city:state,and ZIP code) Y/L/!l'
Does applicant awn property in any other If yes,what county? . What Tema District? Has this deduction been requested on property
county in Ind®iaa? for current year?
❑ Yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved M the anssmt nr— —
_- --20 20 I0GEsTadI LAQRy c _ 20 20 20
PAutA S
Signature of Count) :aunty Date(month,day,year)
I l We certify us 14 113 lion is true and correct and that the applicant is a resident of Indiana and
owner 1 contra( ed.
Sig re(owners I Date(month,day,year)
Full resident addres .. .._ _._ r,sane,em m✓code)
3R a-S 3 °10 E 0A k to n A C.+7 sty (-( 7 co 0 6
Person 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) .
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