HomeMy WebLinkAboutMortgage_Wilmes a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
ti ` FOR DEDUCTION FROM ASSESSED VALUATION L
° - State Form 43709(R11/6-09)
Prescribed by Department of Local Gonemnrent Finance
INSTRUCTIONS: DEC 21,e .
Tb be filed in person or by mail with the CountyAuditor or County Recorder of the county where the
Form trail With:
Ring Dates: 1) Real Property.Must file during the ic ty property is located
nog year for which the deduction is sought Aar
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)month
before March 31 of each year the deduction is sought - ur�(iRecorder
See reverse side for additional instructions and qualfications. GIBSON COU - AUDITOR
Ap• (owner or contract buyer-see restrictions on reverse side) .
Key number/leg. •esaiption Record number Page number
A District K
‘ 416.- 8- 3(0 - 300 - ooa., 600 - oa_ 4! cot( 4950
-•value of real property as o/ Mortgage/Contract indebtedness unpaid as of Mortgage/Contact Indebtedness unpaid as of Is the appricant the sole
. . 1,anent year Mardi 1,current year date of applica on legal or equitable owner?
p( 0 D) O Q D ❑ Yes ❑ No
lino,what's his/her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract seller hat n ,1
ss
Addr of mortgagee or contract safer(number and street,city,states land ZIP coda)
Name of assignee or other owner or holder of mortgage
Does ant own (number and sheet, • ,tare /
7 � a.
Does apprmant own property in any other If yes, t county? • What Taxing District? I Has this deduction been requested on property
county in Indiana?
❑ Yes ❑ No -- tnr n.nnntu�n
COUNTY AUDROR --- ---~`- J� I/ '
Deduction approved in the amount of - T U`L'T
Drawer \O•.
20 20 20 20 20_ 1/I -O
V
Card NO. l
'Signs ol Cormry Auditor . County
I I We certify under the penalty of perjury that the above and foregoing Information is true and cone -
owner/contract buyer of the aforementioned property on date application is filed. .
Signa(ar� me nam) Date(moth,day,Year)
street,<sly,state,and ZIP code)
kFI62n5 r oPk n )trtvl 14-m.41951-11.414- IN 41639 .
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
.) Address of autl d person (number and street pry,state,and LP code). - _ ... - _— --.— _— —