HomeMy WebLinkAboutMortgage_Dewig STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
"_•"41:yr FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RU/6-09)
.'A.- Prescribed by Department of Local Government Finance
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INSTRUCTIONS: B m .4
��LL �"fonn filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property i ted.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought , Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must R 15
e during the twelve(12)monthAPR
before March 31 of each year the deduction is sought. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(ownerJJ' ` °°�'`��buyer- resfnbtioris reverse side) (�
l�l/1(A 1`� e�0.1111P11124-2 J �,J-/e�(/,�LICEIhQt/}� GIBBON COUNTY AUDI0R
Taring District Keylw� >Z3-DI -9 o O - V V�C•I V f p f-Ot� Record nu� Pa9���li
Assessed'retried real property as of O`/] Mortgage/Contract indebtedness unpaid as of Mortgage I Contract iidebtedness unpaid as of rs the appfrant the sole
Math 1,current year Marti aprsyylSr date of a legal or equitable owne• r?
♦eixo ❑ 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 is different than that of applicant-indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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Address of mortgagee or contract seller(number and street,coy,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and street,city,state,and ZIP
Drawer NO... Q�. ......••
Does applicant own property in any other If ye: �� :deduction been requested on property
county in Indiana? rot year?
❑ Yes ❑ No Card NO. 1� __ ❑ Yes ❑ No
Deductions 417(2 15 /L-W-� . . - -- _
approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor - County Date(month,day,year)
I 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 th forementioned property on date application is filed.
Tiigpatrae waarar� ,� i`. i 3
•ua 't address (number a 4 state,and ZIP code)
101:7/9 2 5,25 EE 2-1a441-4.0/41/2G3
7 . •
Person authorized by duly exeaaed Power of Attorney or by IC 61.1-12-0.7 - Date(rtonth,day,year)
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Address of authorized person (number and street,coy,state,and ZIP code)