HomeMy WebLinkAboutMortgage_Monk (2) �. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'=��r;; FOR DEDUCTION FROM ASSESSED VALUATION _ _
I!". State Form 43709(R11/6-09)
Prescribed by Department al local Government Finance _ i i!
INSTRUC77ONS: 7 ; '
b be filed in person or by mad with the County Auditor or County Recorder of the county where the roe
Form fi
Pe Y N H 4' property riY is located-
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. L �, �fptylly Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months [u(,f
before March 31 of each year the deduction is sought - lvmty Recorder
See reverse side for additional instructions and qualifications.
b u y e r contract e rasuge�s on reverse side) GIBBON C OUNTY q UpI TOR
Ta D'/� --"el may`— Key 0 ' 1;,of- ►° 3 - oo /, 3 ?1 - 0 �.g f ._0 number Page
Assessed value of_irad property. as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the appGOnt the sole
Mardi 1,anent year Mardi 1,parent year date of application legal or equitable owner?
L1 DO v ❑ 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 appgcant.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 seller )
Address of mortgagee or contract seller(number and greet,thy,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Add of assignee(number and greet ct)1 gate,and ZIP code)
. Q�.et_. X' P i /9
Does • awn property in any other If yes,what county? - What Taring District_ 7 I Has this deduction been requested on property
coon in Indiana? ❑ Yes ❑ No �co?ent year?
Drawer NO Y— .... r»COUNTY AUDITOR Deduction appro+ed lo the amount aF. I Card .1\r O. ..... 358 3
20 20 20 20 JJ •••••
(D(. . 02161QA —
Signaar Wi y[c Camry Auditor j AA v"'— County •
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 contact buyer of the aforementioned property on date application is filed.
\ Signs (o e/s Nil (.........., ///� Date(north,day,year)
Full dent edtl appl t(number and t alll state,and ZIP wtle) / /
Person authorized by duly executed Power o Attorney or C 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) •