HomeMy WebLinkAboutMortgage_Kolb (6) t..1. : STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
-cc._ 2.5. State Form 43709(R11/6-09)
Prescribed by Department of Lod Government Finance
F ile �1
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INSTRUCTIONS: adlgbla'�•
To be filed in person or by mad 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
2)Mobile I Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months J N ty
before March 31 of each year the deduction a sought - bounty Recorder
See reverse side for additional instructions and qualifications.
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Pppfpant(ownterwcoq a�tbuyer-see restrictions y}�V`/"
'I/ky11.�1/K_buyer`�Mreeestri'/�. '°(/' .�1` r'rO(` (��/� GIBBON COUNTY AUDITOR
Taxing District I ` J //L¢Oall desm �o 0 _ t L ^ Record nu Page number
/ L 000 Assessed value of real property as of p/1 Mortgage/Contract indebtedness unpaid as of Mortgage I 'Conuac/ indebtedness unpaid�d Is the applicant the s
March 1,current year March t / n1t year date of application legal or equitable owner?
Lin Uw ❑ 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&Recent than that of applicant.indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Montle Home(IC 6-1.1-7)
Name of mortgagee or contract seller O IC r
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) •
Does applicant own property in any MI c t? Has this deduction been requested on property
county in Indiana? ❑ Yes ^ - for current year?
Drawer NO •O��I
3 ❑ Yes ❑ No
Deduction approved In the amount at.
Card NO.
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20 20 qi ,3563'6 20 20
Signature of County Auditor —I 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.
(oyQtefs name) Date(month.day,Year)
FUJI G.'�1,aL�>✓
u0 t address Qf applicant(number and ci2) state,and ZIP code)
Person authorized by dult executed Pawn of Attorney or by IC 61.1-12-03 Date(month,day,year)
Address of authorized person (number and street ply,state,end ZIP code) .