HomeMy WebLinkAboutMortgage_Beloat t` STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
- State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
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INSTRUCTIONS: _- i i'i
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To be filed in person or by mail 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. Coin Auditor
2) Mobile/Manufactured Homes not a^^-sled as Real Properly Must file during the twelve(12)months N attar
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before March 31 of each year the deduction is sought u
See reverse side for additional instructions and qualifications.
App cant( V m'�b` � anrewe �� „ Q,�,,, -h GIBBON COUNTY AUDIT[)a
Taxing District / ,Key` number/legal description "�- -u^ Record number Page nu
- l a-Dg- lea- oco f 6-ox7 13 6'7
Assessed value of real property as of Mortgage/Contras indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,anent year date of application legal or equitable owner?
❑ Yes ❑ No
If no,what is his I her exact share of interest? If awned 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 ❑Annually Assessed
- Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract setter
•
Address of mortgagee or contract seder(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 awn property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current year? ❑ Yes
❑ No
COUNTY AUDITOR
Deduction approved in the amount at
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 I contract buyer of the aforementioned property on date application is filed.
-wnefs lue nerto) / Date(month,day,year)
• •_. II 9,0
F• •eat address of a•..ten (number and street ciy,state,end 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 street city,state,and ZIP code)