HomeMy WebLinkAboutMortgage_Davis (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:. g ! �1
r'; FOR DEDUCTION FROM ASSESSED VALUA
State Form 43709(R71/609)
Presaibed by Department of Lod Govemmem Evans
File Mark
INSTRUCTIONS: MAR 2 0 2015_ Form filed with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the prope is located.
Filing Dates: 1) Real Property Must fee during the year for which the deduction is sought County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must A ling th ve . nths
before March 31 of each year the deductions sought County Recorder
See reverse side for additional instructions and qua lifications. GIBSON COUNTY AUDITOR
Appfirem(owner or buyer-see on reverse e)
n L oC� Rio. oC Cam �'1 r avao
Taxd istrF2 Key n ber/legal desorption Record number Page number
02647-oi—boo—oo4. i �oai Po'3 //Vhf
Assessed value property as Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apps t the sole
March 1:amert year MmM i or date of app�tun legal err equitable avne/l
?9oOo - ❑ Yes 0 N
If no,what is his/her exact share of interest? ! If awned with someone other than spouse,indicate with whom
If name on record is deferent than that of applicant,Indicate belovr. Is the property in question:Annually Assessed
❑Real Property ❑MrwallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller • 3
Address of mortgagee or contract seller(number and street, state,and ZIP code)
Name of assignee or othr owner or hnlne.^r^ -_
Drawer NO °2oi * ""
nty? • What Taring District? Has this deduction been requested on property
1 / / /L I
for arrest year? ❑ Yes ❑ No
Card NO. •
/ / /
COUNTY AUDITOR
-
1
•
20 20 20 20 20d . 20 20
Signory, of County Addmr ' n f�y 1_ _
.c ./JfJ�J--' • County Date(mm/y,�'; O,il.It�'.h(O�Fi41h•'y_ V� o—IS
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 contract buyer of the afore properly on date application is filed. .
K� S gnaw (oln,�n^me t / ( I Date(most,day,year)
�" b 37163 °` j a ,r! j✓Vl nL-1 .Dr . auensiii/k _774/ • V76 /v
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,city,state,and ZIP code) .