HomeMy WebLinkAboutMortgage_White (7) r . .< STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ; (r s tt--r
FOR DEDUCTION FROM ASSESSED VALUATION •
�_'= .' State Form 43709(R11/6-09) A i t i -
Prescribed by Department of Local Government Finance �,I �/
INSTRUCTIONS:
!ZIP� ` 2014
To be tiled in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form filed wadi.
Filing Dates: 1) Real Property.Must life during the year for which the deduction is sought. *• `•k n/. ditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months /i,r-- r/�%il`'/r
before March 31 of each year the deduction is sought _ GIBSON M U ,"- tAeenierR
See reverse side for additional instructions and qualifications.
-u'r - or contract buyer-spq restrictions an side r
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/ i ,da i oho s�avc._ c _ Gb'Y ` emit 4 -15-_
• �..vab a areal property as of ge/Contract indebtedness unpaid as of Mortgage I Contract hrdebtedness unpaid as of Is the applicant the sole
Marsh 1:anent sear March 1,current year date of eelfrcatirn ap legal or equitable owner?
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❑ Yes ❑ No
If no,what Is his/her exact share of interest? I If owned with someone other than pmma,indicate with whom
If name on record Is different than that of applicant indicate below: Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of nxxtgagee or contrast seer a d/�
Ad 4(
Address of mortgagee or contract seller(number and street coy,state, ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,ray,state,and ZIP code) /�/�//j y(�//n{ //f�/�/
S��/ir e- :1-4 4 jj//}jj} i / ii- Deer on property
Does applicant own property in arty other ' If yes,what county? - What TaxudDiktricl? Has this dedu p din
county m Indiana? ❑ Yes ❑ No ll// wont ❑ Yes ❑ No
- COUNTY AUDITOR
Drawer NO. a 20 20 20 20
f. Card j/ 0. ...... County Date(month,day.year)
I/We certify under the penalty or',yip., __ 'mooing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on ate application is filed. .
j Sig re(ov efs fun naineEL31.4 Date(month,day, ea
r)
li-ill-/4
F d en Y address of appfrant
(nu,S and street ay,,state,and ZIP code)
1805 S11 In ?tn Wen rat L f?.p13
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 oily,state,and ZIP code)
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