HomeMy WebLinkAboutMortgage_Ashby (3) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R11/ /LED
Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is 11 F Acrd
Filing Dates: 1) Real Property.Must Me during the 1 5 ' �
g Homes year se as which the Property is sought d County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)months
before March 31 of each year the deduction is sought. county Recorder
See reverse side for additional instructions and qualifications.
Applicant(ofryor contract buyer-see res tp use side)
GIBBON COUNTY AUDITOR
T ' , Key number/ /?- J03- OOO. //8_016 0/.3 P�a?of9
Assessed value et real property as of Mort page/Contract indebtedness unpaid as of Mortgage I Contract Indebtedness unpaid as of Is the app&ant the sole
March 1,anent year Mart3u 1,arrtrnt year date of avP&atfon��b�r °`� legal«aquitable owrrel/
❑ Yes ❑ No co
spouse,indicate with whom
If no,what is his/her exact share of interest? If owned with someone other than
If name on record is different than that of applicant,Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
y//,/,,� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract setter, it //�e�/��'�'-
Address of mortgagee or contract seller(number and street city sea ,and ZIP code) -61J
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,ray,state,and ZIP code) I 115#L V/ RCMEr C
Does applicant own property in any other If / r I
county th Indiana? ❑ Yes Yes.what of {�/]�` / or /��f1/� been requested on property
❑ No / y /�+� (�'- ' Ir- r I ❑ Yes ❑ No
V ,/`
Deduction approved In the amount of. 17(/ 7�
20 20 20 it
20
Signature of County Auditor /(,3—/4::;b1.9.) �'onw,day.year)
1 I We certify under the penalty of perjury that the above ai :is a resident of Indiana and
owner f contract buyer of the aforementioned property on 1
Sig ire(owners Ml na-•) 1.77:4191:17:3
Full resident address of a t(number and -;or city,state,and
)3 as-E Locust 0 treeh -r_t-cs._I 0
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) w
Address of authorized person (number and street,city,state,and ZIP code)
. 1\1\