HomeMy WebLinkAboutMortgage_Braswell as STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
�tFOR DEDUCTION FROM ASSESSED VALUATION
'"fi' State Fonn 43709(R1116-09) I 1 i /
Presmbed by Department of Local Government Finance - ipi
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INSTRUCTIONS: a( .
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. F f d t ,
FITmg Dates: 1) Real Property:Must file during the year for which the deduction is sought Court itor
2) Mobile/Manufactured Homes not assessed as Real Property Must Re during the twelve(12)months
before March 31 of each year the deduction is sought - nh R er
See Applicant ter or contract bryer--see restrictions on vvrse side) GIBSON (:f1UNT?.AUDITOR
4 :�,�L � � �c L. 1 C six
T.: .District Key number lega description Record number Page number
• ,, _ _1 >r _a. a- - •_ - , - . . . - 4t, 20 I4 a',. b(o
A s s e s s e d v a l u e areal. .. a s• of Mortgagge!Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applkwtt the sole
March 1:amen'year March t,cu �p date of aPPrtcation legal a ilable No
tf no,what is his/her exact share of interest? ) If owned with someone other than space,indicate W ah whom
If name on record is different than that of applicant,indicate below: Is the property in Question:Annually Assessed
Real Property ❑Annually Assessed
o�7.`t • Mobile Home(IC 6-1.1-7)•Cam` lam` t contract seller /
Address of mortgagee or contract seller(number and sheet,city,state,and ZIP code) 7
Name of assignee or other owner mortgage er or holder of mo - —
Address of assignee(number and street,city,state,and ZIP code) ,(\`-,\ P
Goes applicant own property in any other If yes,what county? • What Taxing District? V �� L/y. " `
county in Indiana? ❑ Yes o /
J
COUNTY AUDITOR
Deduction approved in the amount of \��
20 20 20 20 20 - 20
Signature of County Astor 6 County Date(month,day,rat)
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 1 contract buyer of the aforementioned property on date application is filed.
Slgnatu�r�hN m 34...(24.066 Date(month,day,year)
rs: ont address of t(number and street,dR stale,and ZIP code)
P7/3i9 ,lJ 7 z,)L 4tar/.� 1ti g77•"1,
authorized by duly executed 1 Y mein IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and sheet,city.state.and ZIP code)