HomeMy WebLinkAboutMortgage_Baumgart (3) C& STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
�` = State Form 03709(R11/6-09) a
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Prescribed by Department of Local Government Finance IdE
INSTRUCTIONS: mad�Mc c
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. A P I7 O L U 15
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought. 0 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months rt
before March 31 of each year the deductions sought `N//O/,{ ^t&
See reverse side for additional instructions and qualifications. G I B S O N COUNTY At IniTO p
Applicant(owner or contract buyer-see reess�trictions on reverse side)
T ' 9 District Key number/legal d— 'titian Record number Page number
dto • 23 -o A _ Hoa- — ooa . S2.toA 92013 9os0)-
ed
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1:wrest year Manh 1,anent year date of legal a equitable owner?
00 0 Yes 0 No
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 different than that of applicant,indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Motile Horne(IC&-1.1-7)•
Name of mortgagee a contract seller 7
Address of mortgagee or contract seller(number and street, ZIP code)
Name of assignee or other owner or holder of mortgage —- - - __________
Address of assignee(number and street,city state,and ZIP code) (70/.3
Drawer NO.
O..,,,.
Does applicant own properly in any other If yes,what county? Wha •••••••••••., erty
county in Indiana?
❑ yes ❑ No I No
Card NO. ...., 0�
COUNTY AUL
Deduction approved in the amount of
20 20 20 20 20_ 20 20
Signat of County Date(month,day,year)
I/We certify under the pen try of of pe the above and foregoing Information is true and correct and that the applicant is a resident of Indiana and
owner 1 contrail buyer of the aforementioned property on date application is filed.
(c. sill (owners NO na Date(month,day,year)
loci number �9-
residentaddressof t s street state,and ZIP code)
A 106R4 S. Oat ¶ !sere Cam--. R-agi,s+tA4-�u/ 97&30 •
Person authorized by duly executed Power of Attorney 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state.and ZIP code) .