HomeMy WebLinkAboutMortgage_Brewer (4) ail STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
kn.,10 FOR DEDUCTION FROM ASSESSED VALUATION _-.. 17- State Fonn 43709(R11/6-09)
2-i' Prescribed by Department of Local Government Finance •( i a i—.
INSTRUCTIONS: '. !�L�./i�l.,
-onn life:with: .
lb be fled in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought 04�DovebtA�gLrt,t[
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months IV V V ZUTJ
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications. r.I
App&rant(owner or contract buyer-see monitions on yde) "1 �""- "mo b
nw - GIBSON COUNTY AUDITOR
Taxing District V
of l,- Ck 18-legal 039-0gV:, 19 Page number
Assessed value teal property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1;anent year March 1.7s ea V v date of application
legal a equdable avnet?
If no,what's hs!her exact share of interest? , If owned with someone other than ❑ Yea ❑ No
spouse.indicate with whom
If name on record is different than that of apolicant Indicate belovr. I Is the property in question:Annually Assessed
IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller pit
_
(\,..9-r\t-1`e1-------
Name of assignee or other owner or holder 1//11 S
Address of assignee(number and street,c a� `i S J t
'Does applicant own property in any other �(��, openY
county in Indiana? ❑ Yes S/ J 'VQ(r ❑ No
Deduction approved in the amount of: S) C
20 20
Signature of County Auditor
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/contract buyer of the aforementioned property on date application is filed.
' naturet/s full name) /] Date(month,day,year)
' ent address of applicant(number and street,a11t state,and ZIP code)
SO 7 €1.4 Vint_ SA-rce.,arI Ford Brand- / IN 47 4 `l8 -
P authorized by duty executed Power of Attorney a by I 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)
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