HomeMy WebLinkAboutMortgage_Moore STATEMENT OF MORTGAGE OR CONTRACT INDEBTE ..h Township Year
v�;: FOR DEDUCTION FROM ASSESSED VALUATIO
State Form 43709(R11/6-09) r
Presented by Department of local Government Finance -
File Mark
INSTRUCTIONS: 2015
FEB - Form fled with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located.
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought ei et County Auditor
•2)Mobile/Manufactured Homes not assessed as Real Property Must file du ' %4).i I•-4.y)br•nths
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications.
GIBSON COUNTY AUDITOR
Ap t( or contract buyer-see'esthetic/sr verse side)
rte/ \i,2 /� �
lT�a ' 0'� �. Key number/legal desai Record number Page number
` l tndi Z!o-(9-3 4'Cb eW 7156- ZO/ a b/6 0
Assessed value of real properly as of ortgage/Contract indebtedness unpaid as of Mortgage I indebtedness unpaid as of Is the apparent the
March 1;arrest year arch 1,current year date of application legal or equitable owner?
17 3 R • ❑ Yes ❑ No
If no,what is his l her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller/4 •
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,coy,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
county in Indiana? ❑ No year?❑ Yes for aurent year? Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
'Signabae of County Auditor 4 County Data(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. .
W(avgers )� +/%//�/� Date(month,day,year)iu
Full resident address oTa"rcant(hum r end street,aTy,state,and ZIP code) ' I
V 7a8 E. lau/e/fie C#: Had bjf"gdf 1/v 7' 743`1
Person authorized by duly executed f Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and.meet city state,and ZIP cede) .