HomeMy WebLinkAboutMortgage_Pauley (3) tom?: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
�5,4:, State Form 43709(R11/6-09) F IL
Prescribed by Department of Local Government Finance
to a
INSTRUCI7ONS: I f.
To be filed in person or mail with the Court Auditor or County Recorder of the county where the eiAN o d C u IJ N'
Pe by h h ty properly is lopt
Fling Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ County Auditor
2)Mobile/arch 31 of ea each year not eduction i as Real Property.Must file during the twelve(12)montflq, Recorder
before March 31 of each year the deduction is sought ,/,fp/((, - WM.{NM41
See reverse side for additional instructions and qualifica tions. ^ GIBSON COUNTY AUDITOR
Apt:6c t(owner /,b�uye_/rr-ssseeeewrastr. . verseside) ,� /t � / 7 Taber
Taxing District �`/�1�� V"�•1•(•--i f -Ld�8- 30 Li-coo yel(�( -7 i 1-{IO/ 2_ •_ /�C�..1G4nn QRe 16- JW Ins Key
Assessed value of real property as of Mange e/Contract indebtedness unpaid as of Morigi age I Con indebtedness unpaid as of is the applicant the sole
Mare l;aarort year rrh year date of aPPGca tion legal or equitable Amery
�D ❑ Yes ❑ No
If no,what Is his/her exact sham of interest? I O 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 Name(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seder(number and stree city, te, code)
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 If yes,what county? . What Taxing District? Has this deduction been requested on property
wanly in Indiana? ❑ No for anent year? ❑ No
❑ Yes ❑ Yes
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor - County 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 ntract buyer of the af? t.g4.e&.Ct�n�entioned property on date application is filed.
nature( jhp ) /� / Date(Montt,day,year)
CF Brit r/oof a♦ppliannt(n•• be/` and LP wile) ��� 7Q
au/Q
P authorized by drily executed Power of Attorney or by IC 6-1.1-12-0.7 t Date(north,day,year)
Address of authorized person (number and street city,state,and ZIP code) .