HomeMy WebLinkAboutMortgage_Oneal tom.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RU/6-09) }' 1 fy,f,f F.
Prescribed by Department of Loral Government Finance l• '
File Mar&&'
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. A6221/014
Ring Dates: 1) Real Property:Must file during the year for which the deduction is sought 9 County Auditor
2) Mobile I Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought - J(L_ er
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Applicant(owner or contract buyer-see on reverse side)
a--n_ a .� )1,1 ( rhs-ems
T . g District Key nuaber/legal description Record number Page number
d — /9-05- 400 . o01. )--o 7 - o). 5 14 I `i 4x.3-7
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the appfrant the sole
Mardi 1;anent sear March 1,anent year date of application legal or equitable owner?
138/-00 n El Yes El No
If no,what's his I her exact share of interest? If owned with someone other than spouse,Indicate with whom
If name on record is afferent than that of appfxant,Indicate below- Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
• iv- Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller -_ c LA
Address of mortgagee or contract seller(number and street,coy,state,and ZIP code)
- Drawer hl
er \ ..g0 .....
Name of assignee or other miner or holder of Mortgage U �'y
Add f assignee(number and street,city,state,and ZIP code) Card N O. . ...... ..... .
T NW SE S- 3 - to / .004 c
Does own property in any other If yes,what county? . What Taxing District? W I "mil ,..�in.gcny
county in Indiana? ....No nn yea ❑ Yes ❑ No
I:1 Yes ta h
COUNTY AUDROR -
Deduction approved in the amount of. - `-
20 20 20 20 20 20 20
Signature County Auditor • / ' 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/contract buyer of the%a afffo-rementioned property on date application is filed. .
SSre��'l 0%ti Date(month,day,year)
ull resident address of apple ant number and street,aty,state,and ZIP code)
//22 c E. S�OC .o�fti . Pr;eice far, ;SiIJ 1176 7 0 •
Person authorized by duty executed Power of Attorney or byi1C 51.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,state,and ZIP code)