HomeMy WebLinkAboutMortgage_Kelle STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
_=C'.• state Form 43709(R11/6-09)
Presm'bed by Department of Local Government Fnarce 1]1
.YAy�' ti Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor 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 f,1„ Goru1N Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the tweke(12)months JA H2 yCotiT/thllTfYj SR
before March 31 of each year the deduction is sought ecorder
See reverse side for additional instructions and qualifications.
uQ /m�o-ad aye re sde) Y 9 /� AA GIBSON COUNTY AUDITOR
Taxing• r..
-/9a/-�a0 -oo4i4in571'-001/ Page number
A - • value of real property as of I Mortgage/Canted indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year I Mann 1,current year date of eel:IS: lien (�1 legal or equitable owR
ne
AO, 0CJO ❑ Yes ❑ No
tf no,what Is his/her exact share of interest? If owned with someone other than space,indicate with whom
If name on record is dP.erent than that of applicant,trdlcate below: Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
o
Name of mortgagee or contra seller
s /��I // L/
Address of mortgagee or contract seller(number and sloe='city, --'_) r
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,ay,state,and ZIP code) )
mu a(-- - _ / '�yME What Taxing District? f�a rtissm�YeaR �requested on property
— WE LIE 1 t�AT PAP W ❑ Yes ❑ No
LC•A Mir 11' :OUNTY AUDITOR
Dedaalk /Li-din
20 20 20 20 20
I I I
Signalize of County Auditor • County Date(month,day-year)
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/contract buyer of the mentioned property on date application is filed.
1 ' Sig (ov a Date(month, ay,yea
Full resident address of t(number and.street,dty state,and ZIP code) ,
2 7"( 06 9- 1N;( (ow� o::K L� Oweflf ,:(lB iN 2-i 766.5
IPerson authorized by duly executed Power ofAttomey 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) .