HomeMy WebLinkAboutMortgage_Brown (10) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
',:'=9.;
; State Form 43709(R11/6-09)
Prescribed by Department of Lod Government Finance F I eFp
c
INSTRUCTIONS:
lb be fled in person or by marl with the County Auditor or County Recorder of the county where the property is located. F 1«m Bed tvritR
Ring g Dates: 1) Real Property.Must file during the year for which the deduction is sought NO 1 01 Z W9anty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must the during the twelve(12)months
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications. II,m, v?*I11
Applicant(owner or contract buyer-see restrictions on inverse side) GIBSON COUNTY AUDITOR
1
, ) # se
T District Key number/legal description Record number Page number
p a6 -iA -05 - waO - coo. /6; -aa7 2004 Cox s6
Assessed value of real property of Mortgage/Contract indebtedness unpaid as of Mort gage/Contract indebtedness unpaid as of Is the applicant the sole
Marsh 1:anent year Ma 1,anent year date of appfrcation legal or equitable owner?
I !o CFI 5 0 0 Dyes ❑ No
If no,what Is his t her exact share of interest? If ovmed with someone other than spouse,indicate with whom
If name on record is drffensnt than that of applicant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller,4 ( jf' .
Address of mortgagee or contract seller(number and street,city stlfe,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address hassignee(number and street,coy,state,and ZIP code) 1 I
. fT Sf S - a -fa /. / 6, 4c . tin W11L iT
Does applicant own property in any other If yes,what county? - What Taxing Dist / J
county in 'Indiana? ❑ Yes ❑ No �/t 04
COUNTY AUDITOR 2ooq- (,a3cp
Deduction approved hi the amount of:
20 20 20 20 2 _.. • cu
Signature County Auclitor, v County Date(math.day,year)
I/We certify under the penalty of off ppeerrj ry that r�the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is fled.
Signature(owner's W came j q Date(month,day,year)
ic)Full resident address of applicant(number and pea any, te,and P code)
r— /301 E. 7Aftaco PNJncek) , XAID ii770 •
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,dry,state,and ZIP code)