HomeMy WebLinkAboutMortgage_Busch (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS • LiToFSShln Year
FOR DEDUCTION FROM ASSESSED VALUATION �
State Form 43709(R11/6-09)
Presaibed by Department of Local Government Finance t'1 �P•• (,,��y�
INSTRUCTIONS: APR a LUIJ
Farm filed wide
To be tiled in person or by mail 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 my Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought GIBSON C OU Y roll der
See reverse side for additional instructions and qualifications.
Applicant r-see on Fe side)
T .-- Key number// description RecoAd number Page number
ALA/1/ o7G- --n-/o/- ooa r ,GEC/-$Gaul pU/J /2 / 7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1;c nerd year March t,current year date of applicationn legal or equitable owner?
/l` IcA ❑ Yes ❑ 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's different than that of applicants Indicate below: Iss property in question:Annually Assessed
`b((Real Property ❑Annually Assessed
• f Mobile Home(IC 6-1.1-7)
Name of wee or contact seller
on alryks4
Address of mortgagee or contract seller(n street,oily stria, LP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
• i
Does applicant own property in any other If yes,what county? • What Taring District? Has this deduction been ran'— may
county in Indiana? ❑ Yes ❑ No for pare¢yeaR -, No
COUNTY AUDITOR
Deduction approved in the amount of: - `n/1; j)
20 20 20 20 " ' C •` —
Q.• J
Signature of County Auditor County V\ \ •••••..••
I/We certify under the penalty of perjury that the above and foregoing information is true a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed. C 3,
Signature(•: en's name Date(month,day,year)
4 / L A_I ads
of applicant(number and ..•4 pry,state,and ZIP code
4� get L. Coyrmuwaso Sr. ,1�rves /N 1174.41.
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)