HomeMy WebLinkAboutMortgage_Foster (9) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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p FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09) FIL
Presaibed by Department of Lttal Cwvemment Branca
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INSTRUCTIONS: ff11 CC t
7o be fled in person or by mail with the CounlyAuditor or County Recorder of the county where the property is Qt ted.3 '1.-r fled with'
Fling Dates: 1) Real Property.Must file during the year for which the deduction is sought 9 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12) .nths
before March 31 of each year the deduction is sought - I • v .ryes County Recorder
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See reverse side for additional instructions and qualifications. G I BSO N COUNTY AUDITOR
Appfram((wrcer or contract buyer-�4 ' on reverse side) �,r St
Taff District '`''CSC.+ Key number I legal description�\.// Record number Page number
7V� a6 .18- 310 - clod -ooa• Iito -oog aoi4 471>
Assessed value Weal property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appIcant the sole
March 1:and year March 1,anent year date of application legal or equitable smell
ISa, aLi 3 ❑ Yes ❑ No
If no,what is his/her etas share of interest? If owned with someone other than spouse,inthcate with whom
If name on reaxd is afferent than that of applicant indicate below Is the property in question:Annually Assessed
p Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sell= - -- - _
Address of mortgagee or contract seller(number and street city,state,a ZIP code) r
Drawer -:O/C1..
Name of assignee or other owner or holder of mortgage
Address of assignee(number arigsoee4 city,state,and ZIP code) Card NO. 1--1�
Does applicant own property in any o If yes,what county? - What Taring D'sbic_ . . _
.
county in Indiana? ❑ No I for docent year?
❑ Yes ID Yes El No I
COUNTY AUDITOR
Deduction approved in the amount of:
•
20 20 20 20 20 20 20
Signature of County /// County Date(madh,day,year)
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I I We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer oft the aforementioned property on date application is filed. .
‹.Slgna7 owner's fun name)ni Date(month day.year)
resident of applicant(number and tlty, le,and P code)
20 / j e.,� S- ,— ABTA 1 , y... y 76.3,
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,stare,and ZIP code) .