HomeMy WebLinkAboutMortgage_Kiesel a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
:':..M1-tom-" State Form 43709(R11/6-09) �{(1
Prescribed by Department of local Government Finance
File Mark
INSTRUCTIONS: I�tt,,�� p pt�
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is locals � 2 (FU9d wM.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. n° County Auditor
2) before March Manufactured 1 of Homes not eduction i as Real Property:Must file during the twelve(12)mopuj Recorder
before March 31 of each year the deduction is sought ,/lN./l[[ nM
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
Ap owner or b - ,.....„all Terse side)
Key number I legal eesaipti6n C, Rend number Page number
a � - ate -o3 -�� ,i3 ' g O q c20/4.7 3776
r value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of La the apprmant the sole March Lament)ear March 11,current year date of application legal or equitable ovmell
/`/OOC) • El yes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse,Indicate With whom
If name on record is efferent than that of appn4 indicate below: the�e p-ro1perly in question:AnnualyAssessed
t 'eal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of tract seller
Address of matgageaCioantract seller(number and sbee4 city,sate,and ZIP code)
Name of assignee or other owner or holder of mortgage
--
Address of assignee(number and sbee4 city,sate,and ZIP code)
Dees applicant own property in any other If yes,what county? • N/hai /J^/ (� rh
county in Indiana? (!�•� ........
❑ Yes ❑ No i No
Drawer �O••
COUNTY AUDI1 • 3 P,..
Deduction approved in the amount of. • Card NO. ......
20 20 20 20 20 20 20
Signature of CountyAuetn 4 County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
gnabne(or full rama))n'd///Jo k<p r1 ///f Date(month,day,year)
Full resident address df applicant(number and street al%sat ZIP code) ,[
/bias S. 3io (../. egat(,�5 4 low *763q
authored by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day,Year)
Address of authorized person (number and sbee4 city,sate,and ZIP code)