HomeMy WebLinkAboutMortgage_Kelley . „ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State norm 43709(R11/6-09)
;; Prescribed by Department of Lod Government Finance
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INS7RUC77ONS: g ith:--..__--------II!!((1lii�ff'' .
To be filed in person or by mail with the County Auditor or County Recorder of the county where the Form met with:
Pa Y tY N ty property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought a N fl]: slit Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deductions sought - /, ❑ County Recorder
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See reverse side for additional instructions and qualifications. J Il,p�t
Applicant(owner or contact buyer-see?dons once side) GIBSON•°'COUNTY AUDITOR
T s District Key Tnumber l�legal description Record number Page number
,Wi,4Ga cam— Rlo -le- 3 - q(o3 - cado. y3 / - p09 I 30
Assessed value teal property as of Mort gage/Contract indebtedness unpaid as of Mortgage I Contract Indebtedness unpaid asV Is the apprit thei
March 1:acre tyear March 1,current year data of application legal or equitable owner?
1st DSO ❑ yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is date ant than that of applicant.Indicate belovr. �tfb.m�9ppoee.rrt..yy...in
..wq.u esbon
r .n Annually Assessed
e........�.r. _.
Name of mortgagee or contract seller v
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) <fY (/1 l�`-�� •
Name of assignee or other owner or holder of mortgage '-� 0
Aderesso (number and street,�Y.state,and code) // ( , i (�1�.�
Does applicant own property in 2ny other A If yes,what county? • What Taxing D'abict?
county m Indiana.
❑ Yes ❑ Na 1-4C20 I '5 rteIv/-) 3
COUNTY AUDITOR 1
Deduction approved in the anxount of: • O
tI5 ( 1050- °—
20 20 20 20 20_
Signature dCoun nry
I
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 of the aforementioned property on date application is filed.
` Signature(own r� Date(month,day,year)
k.- Full /��f `, n L� �street city,state,and LP code) •
_
\ /*u1s'rRz7 Tv V769
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of truth rs person (number and scree;city,stare.and LP code) .