HomeMy WebLinkAboutMortgage_Georges (2) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
4- FOR DEDUCTION FROM ASSESSED VALUATION
.._....ks-.J State Form 43709(R1116-0g) -�•�
�`^•- Prescribed by Department of Local Government Anne IQ � ] A
INSTRUCTIONS: F I R sgea Form led with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. 2 'A
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought D E 1 2 t1 2n�Gnly Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - ❑ County R>-• •er
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See reverse side for additional instructions and qualifications. I,I• .%rT11.
napfcars . armntract buyer-seeiroes,Notions on reverse alg 6 GIBSON COW TY AUDI UK
TaxinStrict l legal desc iptktbn/7•`/~J Record number Page number
�Q e� a-4 -i3 - .z4 -•300 _ 00/. 687 - 00 y 2 t ' 53a3
Assessed value of real properly as d1 Mortgage/Contrail indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appfir�n the sole
Mandl 1,current year Mardi 1,current year date of apPGcation legal ar equitable awnrer?
F Q coo ❑ Yes ❑ No
If no,what is his l her exact share of interest? If owned with someone othetAhan spouse,indicate with whom
If name on record is dtferent than that of apogean;Indicate below: Is the property in question:Annually Assessed
❑Real Properly ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(n and-stre[)ell city,state,and ZIP code)
co _ _
Name of_assignee or other owner or holder of mortgage
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'"'7777 o OOO P
Add of assignee(number end street,city,state,and ZIP code)
. KY 6w d9-a -9 /. IL A c Drawer No R2O/
Does applicant own property in any other If yes,what county? - What Taxing District
county n Indiana?
....
❑ Yes ❑ No
Card Nip
COUNTY AUDITOR
Deduction approved in the amount of: ••.''••.
20 20 20 20 20 20 20
Signature of Coynrymr - r County Data(month,day,year)
•
I/We%/rti�fy 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 of the aforementioned property on date application is filed.
{o{o-vm�e�/s lug name�///1�� Date(month,day,year)
Full resident address of appfrenl( rand street,all:state,and ZIP code)
x 31Ce2 S. (aSo
Person authorized by duly executed Power C 6-12-0.7 F otFt'y c.%SC . IA-)• 07697
Data(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) •