HomeMy WebLinkAboutMortgage_Brown (4) fa„. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
; FOR DEDUCTION FROM ASSESSED VALUATION
..-4,...;i:t' State Form 43709(R71/6-09) • 4 ,f
Prescribed by Department of Local Government Finance Ir
FilIAL
INSTRUCTIONS: 0y q .
b be Med in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Form 12 2014
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months If'77�7�
before March 31 of each year the deductions sought .WCr rder
See reverse side for additional instructions and qualifications. y�� G IBSONNN771ICOUNTY • a • :
(alrnerormrtfract buyer---.rerirctio reverse side) /r ` 4 '
Tab letrie/ �TKey number/legal description Record number Page number
12 'vn/ayy' A& - is -1)6 -ao/ - 003. S46, -0 a7 20 (y (43Y &
Assessed value of real property as of =rail Contract Indebtedness unpaid as of Mortgage I Conrad indebtedness unpaid as of Is the apt nt Me sole
March i;current year March 1.current year data of 77 tun legal ar equitable owneR
r] / 9/ 0 Yes 0 No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate with who n
If name on record is efferent than that of applraN,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller G34.itte2ieeal_.1
Address of mortgagee or contract seller(number and street, ,state,and ZIP code) -.
Name of assignee or other owner or holder of mortgage �/—/�- . — -
Address of eSSignee number and t P code) T�Drawer��.C f- O `-•i O/ —
CS
Does applicant own property in any other If yes,what county? • What Taxing C lJ H-31 L9
minty in Indiana?
ID Yes ❑ No Card NO. _
i97, i91�� —
COUNTY AUDITOR _
Deduction approved in the amount of ^ (1 1,M w� n
20 20 20 20 - f\ V\)'Ad-C.IJI�i'`^_'-.. lJ'-c''I`i`-�20
Sigru of County Auddw County Date(month,day,year)
I/We certify under t penalty of perjury 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 fled. .
Slgnatu:(owner's ''name,- / Date(month,day,Year)
IIIP L/SealP -
u0 -:,.em address of.,�:I" number and street, ,state,and ZIPccode)
aS? /a,' -Lh&wc ))r 1?-,naIn7 Sit( q7/. 7()
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 r Date(month,day,year)
Address of authorized person (number and street dry,state,and ZIP code) .