HomeMy WebLinkAboutMortgage_Ambrose STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
t'}:� County Township Year
-\`: FOR DEDUCTION FROM ASSESSED VALUATION
', State Fonn 43709(R13!10-15)
�- Prescribed by Department of Local Government Finance p File Mark
INSTRUCTIONS: g 1L�AJ����JJJ
To be filed in person or by mail. Form filed with:
Filing Dates' 1) Real Property:Must be completed and dated in the calendar year for which the decryFjn 2!pal 8
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property is >fl County Auditor
located on or before January 5 of the immediately succeeding calendar year.
2) Mobile I Manufactured Homes not assessed as Real Property:Must file with the ty Rod- county El County Recorder
where the properly is located during the twelve(12)months before Mardi 31 of r is sought
See reverse side for additional instructions and qualifications. G I BSON COUNTY AUDITOR
Applicant(owner or contract buyer-see restrictions on reverse side) /
c_ f, ¢ ,C o-a.QaJz &n d toe 1L
T " g DisTAtrict Key number/legal description Record number Page number
.n,,r) d,-1 7 6 - z a -/ ,s - c300 CO cR - d99 - ozv z-o/ sr 3991
value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
ment due,current year assessment date,current year date of application legal or equitable owner?
709ncf(f ❑ yes ❑ No
If no,what is his I her exact share of interest? If owned 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
-@tea)Property ❑ AnnualyMsc' d
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller n
Address of mortgagee or contact seller(number and steel.city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant awn property in any If yes,what county? What Taxing District? Has this deduott `''l O/ r7
inlndiana? copra yearperty? Drawer NO U a
finer county
❑Yes ❑No onrprot
A person is not enc.-Ned to this deduction unless the,person has a balance on the person's mortgage c (((���
recorder's office(including any home equity line of credit that is recorded in the county recorder's olla 3yy '
COUNTY AUDITOR Card NO. /
Deduction approved i n the amount of .ti .o1�1t41n/)D el 0•V'�
20 20 20 20 20 20 20
Signature of County Auditor -County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is Prue and correct and that the applicant is a resident of Indiana and
owner!contract buyer of the aforementioned property on date application is led.
Signatrxre�fully e) Date(momh,day,yean
$ 01/1i 1,A 9 • ,2 7 /
Fug r ern address of appfi a41,
(number and street city,state,and ZIP code)
/7 4/89 tf. 7J/.ii/�ut,i/lr. Rd lieuh,lk/i .st! V7G3 9
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Dale(month,day,year)
Address of authorized person (number and street city,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.