HomeMy WebLinkAboutMortgage_Money (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
Et', .,4,;, . FOR DEDUCTION FROM ASSESSED VAL Pit
State Form 43709 /6-09)
rnDepartment
Pnns 'bed by of Loral Government Finance F
Re Mark
INSTRUCTIONS: '�//�il�,f� rpr 1 ��nr1�� .
b be filed in person or by mail with the County Auditor or County Recorder of thearNyZhIre2gp f operty is located. Form coed with:
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought N.K, County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property M file during the elve(12)months County Recorder
before March 31 of each year the deduction is sought -
See reverse side for additional instrucUonsand qualifications. GIBSONCOUNT-
V AlJr Ton
Applicant( • or contract buyer- -- .... on revs ) n
ear., �pOA _ �Cil
T. •I istr'ri Key r t f I_ - 4-00- ((o I .917-0 as o f Pia number
Assessed value of real property as of l]l�O ge I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1;parent year tifal,cement ( ) date of application legal or equitable owner?
& -00"' `-� ❑ Yes ❑ No
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 different than that of applicant,Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller �^
ia
Address of mortgagee or contract seller(number and streeeet,city.state,and ZIP code)
Name of assignee or other owner or holder of nongage
Address of assignee(number and sheer,thy,state,and ZIP code)
Does abetment own property in any other If yes,what county? • What Taring District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ for current year? ❑ Yes ❑ No
Nn —
NNTY AUDITOR
�
u a /y
Drawer NO
20 2--(O
0 20 20 20
Signature Card NO. - County Date(month,day,year)
I l 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
r44At‘s comerI contract buyer of the aforementioned property on date application is filed.h'A'l- \ r (`/{y� \ (1 f 7�� ,1 Date(nmtln,day.Year)
" 1 . iJ.l�a1/IIO f!`t UTA�MSN1I k- ZIP 9 'f)U( C
Person authorized by duly executed Power of Niamey 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) .
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