HomeMy WebLinkAboutMortgage_Frederick (2) (C \ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS €curt 1 Township Year
:e FOR DEDUCTION FROM ASSESSED VALUATIO C
4..c? State Form 43709(R11/6-09) T . 7 Y 1
.S ,:.� Prescribed by Department of Local Government Finance Y L _ hart
File Mark
•STRUCIIONS: .
Form Aed with
a be filed in person or by mad with the County Auditor or County Recorder of the county wh en heated.
Fling Dates: 1) Real Properly:Must fore during the year for which the deduction is sought R. County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property.Must file du ' the twelve 02)months
before March 31 of each year the deduction is sought y �— County Recorder
See reverse side for additionalin structions and qu a-lilrfl�caations. GIBSON COUNTY AIIITOp
Apprat(comet•sr l -see'tither/kin
i ‘Key T.0r4 r w U S 3 -o/ /-003. 0/S- OQ Record cord number Page number
i Li value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
March 1:current war March 1,am7 y 70 ^^^ date of application legal or equitable owner?
1 (ff/// 1/ l/ilY/il El Yes 117 No
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If no,what is his I her exact share of interest? / If owned with someone other than^p r its,Indicate with whom
If name on record is ddferent than that of applicant,Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Amorally Assessed
Mobile Home(IC 6-1.1-7)
•
Name of mortgagee or contract seller �/ }
M R.' andZl cod
Address of mortgagee or contract seller(number and street,col:state,and LP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,may state,and ZIP code)
Does epplic .( -- What Taidng District? Has this deduction been requested on property
mumy m In In , J s., /1 for current year? ❑ Yes ❑ No
\\..JJ-a-CC f�(,r�("j/�yJrµ1-Ufr3 p JNTY AUDITOR
20_ I V(—.)(1 y Iq :0 20 20 20
Signature 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 aforementioned property on date application is fled. -
tt SlgnaWn fsJW name Date(month,day.)ear)
1 r---1-27.A
1 4• resid dress of applicant(number and street,ally,state,and ZIP code)
3a(, 8 775 N Hatinn , TA/ W761/0
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)