HomeMy WebLinkAboutMortgage_Church (3) t STATEME NT OF MORTGAGE OR CONTRACT INDEBTE County Township Year
FOR DEDUCTION FROM ASSESSED VALT ��-1JState Form 43709(R1116-09) 1
Presmbed by Department of Lod Government Finance
q 2015 File Mark
INSTRUCTIONS: FEB 1 J Form fled with:
to be filed in person or by mail with the County Auditor or County Recorder of the county where the mope • -•-ted.
Fling Dates: I) Real Property:Must file during the year for which the deduction is soug 1. 4 si ❑ Court Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must fib • 'r% ,l r!T9- 121 s County
before March 31 of each year the deduction is sought GIB COUNTY pucll�Ur`' ❑ County Recorder
See reverse side for additional instructions and qualifications. SON
Appficant(owner or buyer-sea restrictions on� side) -
- rr-r.‘iC1
M o i r
/�N d sesaiption Record number Page number
flo- iu-ig- k(h3Q I. I 'f / oo 7 c oi5 o74I
Assessed value Weal property as of Mortgage Contract indebtedness unpaid as of Mortgage I Contract Indebtedness unpaid as of Is the applicant the sole
March 1,-osnent year March 1.current year date of application legal or equitable owner?
7o�d ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,mdicote with whom
If name on record is afferent than that of applicant Indicate below Is the property in question:Annuaay Assessed
ear Property 0 Mobile Horne(IIC S-1.1-7)
Name of mortgagee or contract seller/3 /—
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 street city state,and ZIP code) - --- - —-- r
. 4'70 CCO C9 s13 /n�J co.
Does applicant own property in any other If yes,what county? • -_ -Wt ``/'�' vperty
county in Indiana? �OI V ❑ No
❑ Yes ❑ No Drawer NO
COUNTY AUI N
Deduction approved in the amount of • Cal)'ci NO
1 y
20 20 20 20 1 20 1 24) _ 20 _
Signature of County Auditor t County Date(month,day,year)
I 1 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.
.to,. :(• nor e) Date(month,day,year)
I W / l
ull resident-••• of ap•i•-• t number and street ally.state,and ZIP code)
�✓A3 s P,iLSOIA sly �k16n4(l'V J-nl `V7ZCO .
erson authorized by duly executed Power of Attorney or by IC 6-1.1-12-0. r Date(month,day,year)
Address of authorized person (number and saee4 city,sate,and ZIP code)