HomeMy WebLinkAboutMortgage_Wright (12) /CSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
IA FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11 i6-013) ME .1 Illki
Prescobed
by Department of Loral Government Finarra
:rill- t - 't
INSTRUCTIONS: - .
lb be tiled in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form rear with:
Fling Dates: 1) Real Property Must file during the year for which the deduction is sought JAN 2 7fl011WUnty 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 - ❑ County Recorder
See reverse side for additional instruct ions and qualifications. •I
. .h'r._��r'n1►r
^pa (owne.crmnbaan -see lam• iii GIBSON COUNTY AUDITOR
Taring c Key number/(legal des (f� Recant number Page number
.26 - /3.- III���oc. /03 - ooy . /s02 . 0 ot 8 a0 AC 472
Assessed value areal property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Gemara indebtedness unpaid as of Is the app ica t the sole
Math 1,anent year Ma 1,anent year date of"ma tin legal or equitable owner?
V6 000 ❑ yes El 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 d'i.7erent than that of appll ant,Indicate below- Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-i.1-7)
Name of mortgagee or contract seller -
Address of mortgagee or contact seller(number and sweet,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage -
Address of assignee(number and stree rny�1h,ard LP code) _ - ---
Does applicant own property in any other If yes,what county? • tested on property
county in Indiana?
❑ yes ❑ No //��J I Yes 1:I No
COL' Drawer 1\O•:-A.�I
Deduction approved in the amount of:
20 20 20 20 Card N O. .. r-IcQ 20
SigrhN a I - I verve Imormm.oar.Year)
I/We certify under the penalty of of per 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 prope on date application is filed. .
)(Signature(o, y- ' I .me) / Date(math,day,year)
y�Full/i�. :..I�`rap. l hoc and-,--t,tube,state,and LP cyder) �At- /� y 76 7 0 .
�1` Person authorized by duty exacted Power of Attorney or by IC 6-1.1-12-0.7 (//\yyr1 Date(month,nthh,day,year)
Address of authorized person (number and street,city state,and ZIP code)
Sift