HomeMy WebLinkAboutMortgage_Elpers (38) 2 _ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS CounF 11 tr./ pear
LoiFOR DEDUCTION FROM ASSESSED VALUATION State Form 93709(Rii/6-09)
Prescribed by Department of Local Government Finance f�,
INSTRUCTIONS: DE� L014
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property Farm mail with
Y tY h ty P party is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought 4 . P! r;; •a-.ttor
2) Mobile/Manufactured Homes not acrnrsed as Real Property:Must file during the twelve(12)months V'fi►�.
before March 31 of each year the deduction is sought GIBSO C.7' 'LA j 8emtder
See reverse side for additional instructions and qualifications. V Ft
(owner or contact buyer- restrictions on reverse sjde)
i) .1 r � �re oc-i(OO
vi,.a District ` r Key number/legal Record number. number
. • 3G c�-c1.0 on( . oSz.- AD y49I
>•value of real as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March ,anent year March 1,current year data of appatation legal are owner?
(Oaia0� `� es 0 N
If no,what is hie/her exact share of interest? If owned with someone other than spouse,indicate with wham
If name on record is different than that of applicant,Indicate below: petty in question:AnnualyAsessed
'Viral Property ❑MrwalyAssessed
Mobile Home(IC 6-1.1-7)
of rtwyag' .or contract sager
attg-tga tee 9Z--
Address mortgagee or contract seller(number and street ray,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and LP code)
�COVI-A4�$
Does applicant ovm property in any other If yes,what county? • What Taring District? aN(,�
county in Indiana?
❑ Yes o C�
COUNTY AUDITOR I4 - Li G [ '
Deduction approved in the amount of: .
l
20 20 20 20 20_ 20
Signature of Cau:tyAuditor County Date(month.day,year)
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 f contract buyer of the aforementioned property on date application is filed.
L re(owner's
fir AA"e
Date(moth,day,year)
• ant addres o applialdumAqand rase Ty,state q nil LP code)
' azs Fritor n uenso■lle Th 4766C
U__erson
authorized by duly executed Power of Attorney or by IC 6-1.1-12-0. Date(moral,day,year)
Address of authorized person (number and street city,state,and ZIP code)
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