HomeMy WebLinkAboutMortgage_Morrison (17) STATEMENT OF MORTGAGE OR CONTRAC D ED rit) County Township Year
s'f' ;: FOR DEDUCTION)FROM FROM ASSESSED VALUAI
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State Farm 43709(RU/6-09
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: AUG 1.62013
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. Fenn fled
Filing Dates: 1) Real Property Must file during the year for which the deduction is ssooyr/yyht K1 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Mus 12)months ❑
before March 31 of each year the deduction is sought NN�o�( County Recorder
See reverse side for...ditional instructions and qualifications. GIBBON COUNTY AUDITOR
Applicant(a. or,, :-b -see restrictions on reverse a•
Taxing oiti Key number/legal description number Page number
a) T-Y-f i4' GQ 4-ao —Oa- 0/ ac'-b OD* a 3 3184
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebteelmoapaid as of Is the applicant the sole
March 1,Curren year March 1,current yelco 0 data of application legal or equitable owner?
❑ Yes 0 N
If no,what is his I her exact share of interest? 1 If owned 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 seller
. C.vw�A_ in+Q.)._
cp
)4\GCC I 50 n
I /// ? Has this deduction been requested on property
^ ( J for anent year? ❑ Yes ❑ No
F U0 j 00 0
20 20
g O %- 3( g-2 Dae( ad.dar.y��
that the applicant is a resident of Indiana and
Date(month,day,year)
y.. L YR A ...A..o.r.,,.
resident address of applicant(n
street city state,and ZIP code)
5(50e1 S L1vl Oil k tg+ `nti 1 III ( 7D4)
Person authorized by duly executed Power of Attorney or by IC 6-1-1-12-&7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .