HomeMy WebLinkAboutMortgage_Wright STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Co wear
'-12 FOR DEDUCTION FROM ASSESSED VALUATION ET
'j State Fonn 43709(RD/6-09)
Prescnbed by Department of Local Government Finance
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INSTRUCTIONS: Je I - I
To be tiled in person or by mad with the Court Auditor or County Recorder of the county where the properly Form coed with:
Pe Y h h h P Pert'is located.
Fdmg Dates: 1) Real Property Must file during the year for which the deduction is sought 1 1 ,Cm ....'..r
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months '. V Recorder r
before March 31 of each =.r the deduction is sought _ GIBSON COP TY A DIT. z
See reverse side -:ddittonal ins . -and qualifications.
■Apparent(• tract buyer.see --.. .,• . revenIt e)
4// # _ '
Keys" r/2, 2 /7- 6Oa .so veal 3 �?ai� Py7/
Assessed value of real of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract• btedness unpaid as of Is the applicant the sole
•
Mardi 1,current year March 1,current year date of appfrcation(/0 rT �g�or Yes ❑ No
If no,what is his/her exact sham of interest? If owned with someone other than douse,indicate with whom
If name on retard is different than that of appfsant.indicate below. Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile 6-1.1-7)
Name of mortgagee or contract seller ?v`_,.e 49 /�//�/)'/y_
Address of mortgagee or contract seller(number aTstreet city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ///��� / /// i' r�
Address of assignee(number andstreet,city,state,and ZIP code) tee/ tr/C,/' '��f-1Y,C
county appp"ss_nttoo n property in any other If yes,what county? • What-faxing District? Has this deduction been requested on property
❑ Yes El No for current yeah ❑ Yes ❑ No
c()_) /(-/ YAUDROR
Deduction appm
20
Drawer NO........ ... . .• 20 20 20
Signature of Cow Card N O. ............... County Date(month,day,year)
I I We certify . ---.-... ,...egotng mtonnation is true and correct and that the applicant is a resident of Indiana and
r t contract o c r of the aforementioned property on date application is filed.
41i1.) 'X�l`• t.(owner's hA =�or Date(month,day,year)
FW resident..-.j�,� of a•' r umber and street,aTy,state,and ZIP code)
Person authorized by duly 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) .