HomeMy WebLinkAboutMortgage_Resler . . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS cop foiwnE Year
aii:SFOR DEDUCTION FROM ASSESSED VALUATION
-�-4 State Forth 43709(R11/6-09)
Prescribed by Department of Lod Government Finance
File Mark
INSTRUCTIONS: F f _ psi .
To be filed in person or by mall 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 I Co my Auditor
2) Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months _ .- Ji Recorder
before March 31 of each year the deduction is sought - GIBSON • ll ty
See reverse side for additional instructions and q • Lions. - •• I R
Appflalit(amerm.•ji' •u1mr-see reSpU�ssv
37/- /r_:.I description') R number P e
pia-o �� oo�.da�-oaf /i' n �
Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1:one year March 1,anent year date of aP owner?
/�) legal or equitable own
raid . o Yes 0 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 different than that of appaant,indicate below: N property in question:Annually Assessed
Real Property ❑Mobile Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /)rt e.2"
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,city,slate,and ZIP code) n 19-. (2.iek-c...._____
Does applicant own property in any other If yes,what county? .
county in Indiana? r-C/.�./v.�Y lr p —
❑ Yes ❑ No n v, Jt.�(�,C,J{/`!�', _
r, 4.0 0_Q C74. unnr '_ri ,' _
C
Deduction approved tithe amount of. - V•
20 20 a9,
moo•
Signature of County Auditor
I/We certify under the penalty of perjury that the above and foregoii coo I > 9
owner/contract buyer of the aforementioned property on date appfi(
1. (owners fu11 nam
i. �S�C.(fc-r/v
11/4 W resident address of applicant(number and shalt,ally,stare,and ZIP code)
Sing I L)a.ber Prine.d.on r4. q?(o?O
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,dry,state,and ZIP code)