HomeMy WebLinkAboutMortgage_Thaxton E 1.._- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. FOR DEDUCTION FROM ASSESSED VALUATION
t '. sPrescribed tate Form43709(RD
by Department/6-09of)
Loral Government Finance L Fl
Ale Mark
INSTRUCTIONS: F � r ; I To be filed in person or by mail with the CountyAuditor 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 M County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - .. r" 'er
-
. `u P "t1 MIr
See reverse`a for additional instructions and quali fications. GIBSON • ' ' • I I •
Applicant(• l�• contract buyer- sidenq� )
Taxing District number/ escription Record r Pa a number
6-1!-D11- W i- coo- 30Q -pax T� 7
Assessed value of real property as of r• ortgage/Contract indebtedness unpaid as of I Mortgage I Contact indebtedness unpaid as of Is the applicant the
March 1;current year arch 1,current year I date of application legal or equitable owner?
40/5-50 - ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someo other than spouse,indicate with whom
If name on nscord is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Houle(IC 6-1.1-7)
Name of mortgagee or contract seller U
Address of mortgagee or contract seller(number and street,city,,sate,and LP code)(�J(�'uA •r(�'
•
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other -— Has this deduction been requested on property
county in Indiana? ❑ for current year?
❑ Yes C (Cie/ / 1_�_yr�. ❑ Yes ❑ No _
Deduction approved in the amount oft /xC 2y//1�' `\`7 3zi
20 20 (.I�r S° 20 20
Signature of County Auditor -.1 Date(month,day,year)
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 I contract buyer of the aforementioned property on date application is filed.
Monett rs Mil nasm/@) Date(month,day,year)
uu W ap nt number and street,city,safe,a LP code) �'
( I b '1 S �-,i.wt 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)