HomeMy WebLinkAboutMortgage_Carey (2) 4,15t.‘:.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Township Year
, I1
�-: FOR DEDUCTION FROM ASSESSED VALUATION
e' - I':.] State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: JUN 4 2013
b be filed in person or mail with the County Auditor or County Recorder of the county where the m Farm reed whiz
ce by ry h ry property is located.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the e 1
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Apprir,$q(owner or contract buys[-/seee restrictions on reverse side)
D Key numbacV legal description Record n bet P e n bet
o 1 aL-05 -3) - Z ca . IL3da JD
Assessed valued real as of Mortgage/Contrac indebtedness unpaid as of Mortgage/Contract inde ess unpaid as of Is the appfont the sale
March 1,and year March 1.airrent year date of application 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 with whom
If name on record is different than that of applicant,Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
• Mobile Horne(IC 61.1-7)
Name of mortgagla tract serer
Address of mortgagee or con and street ray,state.and ZIP rode)
Name of assignee or other owner or holder of mortgage --
Address of assignee(number and street,city,state,and ZIP rode)
Does applicant own property in any other If yes,what county? - D) a%%e)- NO* a O f 3 requested on property
county in Indiana? "••••...,,,
El yes ❑ No ..... ❑ yes ❑ No -
r Card No. ,, 02am
Deduction approved in the amount of: •••••,
20 20 20 20 20 1 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 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.
`(SSlllggna911lowne tMl tea Date(month,day,year
Fu0 //�/rest lyaddresst�d e/ (nu rd street coy,state,and ZIP code) .. _ _ .
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 —Date(month,day,year)
Address of authorized person (number and steel city,state,and ZIP code)