HomeMy WebLinkAboutMortgage_Miller (9) STATEMENT OF MORTGAGE OR CONTRACT I DEBTEDNESS County Township I Year
ggqs'''.(' FOR DEDUCTION FROM ASSESSED VALUATI
State Form 43709(R11/e-09) I L E i :
FTesaihed by Department of Loral Government Finance 3.
File Mark
INSTRUCTIONS: JUN 10 2013 Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. r�(((
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 qury. the.D�AreF�i 2 months [J County Recorder
before March 31 of each year the deduction is sought jWIPrItC�,�
See reverse side for aadditional instructions and ggruuall ificcaaations.�//J /� GIBBON COUNTY AUDITCE
App (ter�1) rte r-sece `-� / °' l�de)X 00 L.
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T C2o2 m cobs fJega �G--/C� —o2D0 OGY� /Co`�—l?/ / I P c2.
Assessed vabie of real as of (,/M,/�orttggaage/Contraa indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as Is the lapplicant the sale
Marti 1,anent year Merit 1,oment 7x36 00.0 date of aPp&ration legal ❑ ❑owner?
(/ Yes No
If no,what is his/her exact share of interest? If owned with someone other than space.indicate with whom
If name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
p Real Property ❑Annually Assessed
)✓/tl���q//}�/��f Montle Home(IC 6-1.1-7)
Name of mortgagee or contract seller f - / I�f n`�/I//�,Ir n'>�_1 E1 C/� V
Address of mortgagee or contract seller(number and scree//t-c$:state.and ZIP code)
C 5 A"`�A�IA-K/l '11
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street ciy,state,and ZIP code) — -
Does applicant own property in any other If yes,what county? - f v.\\et�• rested on property .
county in Indiana? ❑ No
Yes ❑ No
❑ Yes N NLhoka. s �
COUNT I
Deduction approved in the amount at �" U 6/0 r
20 20 20 20_ 20
l I
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.
Sig -. i - fun rte ) Date(month,day,year)•
F f t... _,of t( mbar and street,Wy,state,and ZIP code) //D/Ati__. auuor�d by dory executed Power of Attorney or by IC G7.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,sate,and ZIP code) .