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HomeMy WebLinkAboutMortgage_Graham �._: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year � —;! FOR DEDUCTION FROM ASSESSED VALUATION ,'': J State Form 43709(RN/6-09) .I 'A PPrescribed by Department of Local Government FFinance ;re I -• INSTRUCTIONS: ) To be filed in person or mail with the Court Auditor or Court Recorder of the county where the properly Foy filed Pe by b H N P Pent is located. With: Piing Dates: 1) Real Property Must file during the year for which the deduction is sought MAR _ 0 ()lS,ounty Auditor 2) Mobile/Manufactured Homes not accneced as Real Property.Must file during the twelve(12)months before March 31 of each year the deduction is sought ❑ County Recorder See reverse side for additional instructions and qualifrcatfons. •: ' GIBSON COUNTY AUDITOR As \ a f A1A _4a • �. .r. ..: A1� Taxing District •. d , Record num.- P crire 1 =° ok-© . I. 09 - Dab t. Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole March 1:current year Marts 1,arts t ar date of app�ca tim Iegal or equitable ownC! ❑ Yes ❑ No If no,what a his/her exact share of Interest? S hf owned with someone other than spouse,ind ate with whom da3 Soo If name on record's ddfene nt than that of applicant,Ind below: Is the property in question:Annually Assessed • ❑Real Property ❑Annually Assessed • Mobile bone QC 6-1.1-7) Name of mortgagee or contract seller - - - . — - Address of mortgagee or contract seller(number and sheet,< 1 1ST Ul J `n cY'\ '(�/�/� / _,C1 r Name of assignee or other owner or holder of mortgage v eie�"'' .% "" , 7I Address of assignee(number and street,city,state,and ZIP c BAD V Does applicant own property in any other If yea, - :deduction been requested on property county in Indiana? ❑ Yes ❑ No If ml Yom' ❑ Yes ❑ No � I 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/ l �men' p on date application is filed. re v ) Date(month,day,year) • Full ree'ye9Lad �(�►pira-tlyrm4 osbee ly,state,and Lite . � (\ LI 7 Person✓authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 -`•\Y(,/_L a'J Date(month,day,year) Address of authorized person (number and street,city,state,end LP code)