HomeMy WebLinkAboutMortgage_Emilio (2) f: _3.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �ounry Township Wear
: :, FOR DEDUCTION FROM ASSESSED VALUATIF I L \
_s;:-, State Form 43709(R11/6-09) Il-i
Prescribed by Department of Loral Government Finance
File Mark
STRUCTIONS: AUG 2 2013
`�fo Forrn filed with:
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. gi County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file d j hg the months
before March 31 of each year the deduction is sought County Recorder
See reverse sid: for additional instructions and qualifications. GIBBON COUNTY AUDITOR
f ,+ .^b0 ;. -vena
Ta.00Key /I.I:I description „I Record number Page number
4.i is- in of d Y ! 3 8 s3
- :.vabo of real property as of Mortgage/Contras'eaebtedness unpaid as of Mortgage I Contract indebtedness unpaid as La the appucant the sole
March 1,anent year MarGr 1,cumn year q date of application legal or equitable owner?
;8000 ❑ Yes ❑ No
If no,what is his/her eras share of interest? If owned with someone other than spouse,indicate with whom
If name on record is ddferent than that of applicant.indicate below: Is the property in question:Annually Assessed
1 ❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seder ( ' I / n)/
Address of mortgagee or contract seller(number and street city,state,and ZIP�/codJ e)
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and at--' - le)
.Drawer 1`O•'• r hat county? . What Taring District? Has this deduction been requested on property
for anent year?
M 3 (� ❑ Yes ❑ No•®(] Card.N0, ' ••�:-"•(� ,�.C.^LI i�•, COUNTY AUDITOR
al I bie 7a ^ 'T' y . ,T i
__ 20 20 20 20 20 20
Signature of un �'t« •// / County Date(monW,da�ye p 3
l r/ U
I I e 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.
\/�Siig-')nature(owme full��name)
��. , Date(month,day.year)
/ tID rev tad of appliiwt(number and sheet cty,state,and ZIP code)
lasrl1t S oNEus ?hurt R . NQU) ,IADr, rig 41439
authored by duty executed Paver of Aa«ney 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) .