HomeMy WebLinkAboutMortgage_Ellsworth - STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year FOR DEDUCTION FROM ASSESSED VALUATION
�
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail. ni ed
Filing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sought. orm ed.•.n:
Must be filed with the County Auditor or County Recorder of the county where the property is locate�UL
15 County Auditor
on or before January 5 of the immediately succeeding calendar year.
2) Mobile/Manufactured Homes not assessed as Real Pro a Must file with the County Auditor of the County Recorder
county where the property is located during the twelve(12)onths before March 31 of each year WI • 4Sr —
deduction is sought �Im11��
See reverse side for additional instructions and qualifications. GIBSON COUNTY AUDITOR
APWca roamer or cnntrad/,.Myer-ne sMdlons on reverse side)
Taxing.Disbic6 t yp
K- ember/l Idesoiption loa0tK
Assessed value of real property as of Mortgage I Contract Indebtedness unpaid as of Mortgage I Contract Indebtedness unpaid as of Is the
app ant;th March 1,°mint year Mardi 1,airrent year date of application legal orequ = e
owner?
,2,,S7 SC O G � Yes
❑ No
If no,what is his I her exact share of Interest? If owned with someone other than spouse,indicate with whom
a-) 1-�a-/03 o-Q
If name on record is different than that of applicant,Indicate belovr.
Is the perty in question:Annually Assessed
eel Property ❑Annually Assessed
Na ai of-mortgagee or contacts r r - Mc69e Home(IC 6-1.1-7)
Address of mortgagee or contract seller(number- street dty,star ,and ZIP code)
?sit S. P4/77-E7/vr% %�,e&'7 lilts;pt s7�22-;it/0/ ✓/174/. zY9G.2II
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own properly in any other If yes,what count
county in Indiana? r�� county? what Taxing District? Has this t year On been requested on property
Yee (� No —� for anent year?
D Yes No
COUNTY AUDITOR
Deduction approved in the amount of:
. 20 20 20 20 20 20 20
Signature of County Auditor County I Date(month,day,year)
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 aforementioned property on date application is filed.
Slg r ••diners full me I Date(month,day,year)it,
Full r-`'irnt address of app cant(number and street,city state,and ZIP code)
20 y A,/• h �g_ Ferh/ '£%2,N c76 Ill
Person authorized by duly execred Pourer 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 coda)
■