Mortgage_Obermeier a, . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
f_ ._ .
ate ; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Pnscobed by Department of load Government Finance
•INSTRUCTIONS: a l�:In!.�
artn 1:.
To be filed in person or by marl with the County Auditor or County Recorder of the county where the property is located
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. unty Auditor
. 2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months Al MAY 1 U I J
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications.
,, GIBBON COUNTY AUDITOR
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T.xi 'r«� Key�i tuber/ �J1 Rein number Page num
•C L � at �S�o - /V /. _/.0/ 46/,/�J- Cbz( G )/3 /S
Assessed value af real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appacant the sole
March 1,aarent year March 1,current year date of application /1 legal or equitable owner?
❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate whom
If name on record is different than that of applicant_indicate below Is the property in question:Annually Assessed
Real Property ❑qtr Assessed
• Motile Home QC 57.1-7)
Name of mortgagee or contract seller/err / 2.1
Address of mortgagee or contract seller(number anddsasaseett,,citityy,stare.and ZIP code)
Name of assignee or other owner or holder of mortgage O
Address of assignee(number and street city,state,and ZIP code)
Dees applicant own property in any other If yes.what county? " What Taxing District? Has this deduction been requested on property ,
county in Indiana? ❑ an
Yes ❑ No for=rent year? ❑ yes ❑ No
COUNTY AUDITOR
-Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor • County _I.Data
I/We certify under the penalty of perjury that the above and foregoing urtonnatic Drawer N 1 ��0.........'''• liana and
r
owner I contract buyer of the aforementioned property on date application is filed /5-70
s. Signature h full n me)
- entaddressofappliant(numbera7 street, sbte.and ZIP code)
Card NO. ....•l•
907 dCActr--aor Q.c , F7 6•(9rcFl, /w vie rs- :'l 10, '06
Person authorized by duly executed Power of Attorney or by IC 6-1-1-12-0-7
Address of authorized person (number and street may,stale,and ZIP code)