HomeMy WebLinkAboutMortgage_Browning (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS minty Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Stare Form 43709(R13/10.15) IT
IL by Department of Local Government Finance p ' I
INSTRUCTIONS: e
To be filed in person or by mail. - ,,Form bled with:
Firing Dates: 1) Real Property.Must be completed and dated in the calendar year for which the deduction is sough4OV 1 8 20 0
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is ❑ County Auditor
located on or before January 5 of the immediately succeeding calendar year. my Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly Must Re with the County Auditor of r y. ,�1'
whem the property is boated during the twelve(12)months before March 31 of each year the dud .,• 1''v--,if!�l►F.
See reverse side for addtional instructions and qualifications. GIBSON COU TY AUDITOR .
•
Applicant a er contract buyer-see -",.. .. • reverse side) - -
Tay Disbint- Key number/legal description Record number Page number
%/ °L6- /A -07 / o3 -000 . 7o7- od- g At71 309 /
Assessed value dread property as of Mortgage/Contract'indebtedness unpaid as of • Mortgage/Contract indebtedness unpaid as of is the appGrant the sole
as need date,=rent year assessment date,cement year date of application legal or equitable owner?
a 9 6 O 0 ❑ Yes ❑ No
if no,what is his I her exact sham of interest? If owned with di
someone other than spouse,indicate with whom '
If name on reoad is Efferent than that of applicant,indicate below the p in question:Annually Assessed
Property ❑ Anmratly
Assessed
Mapue Home(IC-1.1-7)
Marta of mortgagee or contract seller - r i..e- /
Address of mortgagee or contract seller(number and street
Name of assignee or other owner or holder of mortgage ' >_
�.\ \Z '��� QY'.6WV\.\1I\� 7c�
Address d--- (number and street afy,state,and ZIP 1
Does applicant own property in any If yes,what--. .
other county
in lndma? ❑Yes ❑No 4� \a p C7
A person is not enftied to this deduction unless the p l , L.
recorders office(including any home egtaay fine of a '
Deduction approved in the amount of: C'O J r", l
k...%\ 20 20 20 C6 •4� 1 C —
Sgnature of County Auditor I/We certify under the penalty of perjury that the above arm roregany,,mini,o.,.,,-----..---...... _
owner/contact buyer of the aforementioned property on date application is filed.
t/�]\/59gnature�(ow lets full name) !� Date(month,day,year)
1 V`.`.".0. )rCVI I aM,itU J V�.M�,
resided address of applicant(number and street 'y,state,and ZIP code)
`I16 '4 A,t`O.t� act', PrirceAor 11. i 41(10
Person authorized by duly erce- Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
•
Address of auewrized person (number and street ray,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000.