HomeMy WebLinkAboutMortgage_Turpin M—�a� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNE S County Township I Year
°es) FOR DEDUCTION FROM ASSESSED VALUATION
i State Form 43709(R11/6-09) \ \ Gibson Montgomery 2013
rerg Prescribed by Department of Local Government Finance Kb
File Mark
.TRUCTIONS:
be tiled in person or by mail. I Form f a nh:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is ht. I
Must be tiled with the County Auditor or County Recorder of the county where the property is located LLT�oditor
on or before January 5 of the immediately succeeding calendar year. OV f�n1n1 County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must tile with the County Auditor of th� 1 3 ZU1c
county where the property is located during the twelve(12)months before March 31 of each year the -
deduction is sought. C!3.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side)
GIBBON COUNTY AUDITOR
Dada S.Turpin 0o5 • //I-7, O a J
Taxing District Key number/legal description Record number Page number
Gibson 26-17-09-200-21 ao: R. 5% 1_
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
118,600.00 0.00 95,815.00 O 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
0 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Top Elite Financial, Inc.
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
123 E.Grand River Avenue,Williamston, MI 48895
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.city,state.and ZIP code)
es applicant own property in any other If yes.what county? What Taxing Distract? Has this deduction been requested on property
arty in Indiana? for current year?
❑ Yes No S Yes ❑ No
COUNTY AUDITOR
Deduction 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 the aforementioned property on date application is filed.
Si Mors full name), Date(month,day,year)
Pia
dde 3 L4 11/1/2012
Full resident address of applicant(number and reef,city,state.and ZIP code)
9626 W.Winyard Place,Owensville, IN 47665
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 , Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)