HomeMy WebLinkAboutMortgage_Mays a. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
" FOR DEDUCTION FROM ASSESSED VALUATION
''= : State Form 43709(R11/6-09)
Presoibed by Department of Local Government Finance 2_ r
INSTRUCTIONS: S E• .
Form In-w.
To be Med in person or by mail with the County Auditor or County Recorder of the county where the property is located.DEC r�o
Filing Oates: ) Mobile/Properly:actured Homes not year
ssessed Real Property Must sought during the twelve(12)monthsC 3 ORoiµ unry Auditor
before March 31 of each year the deductions sought County Recorder
See reverse side for additional instructions and qualifications. J(1_-
ADPI t
(owner a-contract buyer see restrirlansm verse side) GIB$ONCOUNTYgUDITOR
Cta?a� ,C1 t , at,L ;. 711 n
T Distrrt Key number. / description Record number Page number
iLn co a!o-/3 -ao -/off - 000. 0 )- 3 - 00.5 Iy ,
Assessed value of real property as of ge/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the apprranl the sole
March 1:=rent year 1.aurtent year date of aPPI legal a equitable owne?
5 0 0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone othefthan spouse,Indicate with whom
If name on record is dfferent than that of applicant,Indicate belovr. I Is the property in mme'=-...
Name of mortgagee or contract seller ,
Address of mortgagee a contract seller(nr>rr and street,city,state,and ZIP coda) • „ O�,' •y •.... .. —
Dra��'cr 1p.'..
Name of assignee or other owner or holder of mortgage •
5517 • • ' —
Card NO. .....................
Address of assignee(number and street,�state,and ZIP code) 4 Q J /L/O6
M4 c dew-- 3I4 /s / 4 `1i V(p l
Does applicant con property in any other If yes,what county? • What Taxing
g ____...wrested on property
county in Indiana? ❑ Yes ❑ No I mr current Yom' ❑ Yes El No
COUNTY AUDITOR
Deduction approved In the amount of
20 20 20 20 20 20 20
slgrcd of County Aasgr County Date(month,day,year)
I I We cell rtifj 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/contract buyer of the aforementioned property on date application is filed. .
Sig (ovey/s Inca name Date(month,day,year)
Cif/°�
ent address of a number a 4 oily,state,and ZIP code) / Po e'er ( �
111 5. Cross FrahC:SCO / =N Y7�Yy
Person authoraM by duty 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,state,and ZIP code) .