HomeMy WebLinkAboutMortgage_Beasley (3) in
o STATEMENT OF MORTGAGE OR CONTRACT INDEBTE I • Township Year
.;.; FOR DEDUCTION FROM ASSESSED VALUATION ! '�
:i'", ti_ State Form 43709(R11/6-09) I.
p, Prescrtbed by Department of Local Government Finance
JUL 18 2013 File Mark
INSTRUCTIONS: _ Form Ned with:
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. I 1 �� County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must me during the tw.y;, f -14)9i:7p
before March 31 of each year the deduction is sought a
GIBBON COUNTY AUK TO County Recorder
See reverse side for additional instructions and qualifications.
t(owner or contract buyef�ee reverse side)ally 7 i listiia Key number/legal desaiption�/T---{� Record number Page number
iito�+� M dam-/3-7c /o3 - coo 0/ 4 005 / 3aei
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of 1 Is the app6rant the sole
Mach 1,current year March 1.current year data of application legal or equitable owner?
1 7 5-e 6 ❑ 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 read is different than that of apptcant indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of _ tgawntract sett)
•
Address of mortgagee or cconttract sQU(number end 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) 8€4�l.Gt`
/ , m7-4-ey j-
Does applicant own property in any other If yes,what county? - I on property
county in Indiana? ❑ Yes No a
/,3J q8 a 0 N
COUNTI
Deduction approved In the amount of:
20 20 20 20 'by 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.
�nabne(owner's r�ns Date(month,day,year)
p ¶A I 5&2 _ 7-IS-i 3
Flirt ent add a•i,-= t(number rid street,city,state,a LP e)
3o0 s. Oa S • mmccoct), Jr) . inb i`I
Priori authorized by duty exeaihd Power of Attorney or by IC 6-1.1-1 I Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .