HomeMy WebLinkAboutMortgage_Fichtinger STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
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▪ I,,;s FOR DEDUCTION FROM ASSESSED VALUATION TT
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=*i... State Form 0.7709(R71/6-09) g
�' ,.,,,% Prescribed by Department of Lod Govemmant Finance -tai_--„.E,
INSTRUCTIONS:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located. S I t' 3 ni3
Fling Dates: 1) Real Property:Must file during the year for which the deduction is sought LriJ County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months n
before March 31 of each year the deduction is sought - -an •er
See reverse side for additional instructions and qualifications. I , fir
App nor contract b r-see restrictions on reverse side) n GIBBON COUNTY AUDIT
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Taxing District Key number/I description Record number Page number
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Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,current year date of app 7 legal or YYes O O owner?
If no,what is his/her exact share of interest? If owned with someone other tltn spouse.indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
B Real Property ❑Annually Assessed
Mobde Home QC 61.1-7)
Name of mortgagee or contract seller v / • ,
Address of mortgagee or contract seller(nuumber,V r and street,city,stain,and ZIP code)
Name of assignee or other owner or holder of mortgage _
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Address of assignee(number and street,city,state,and ZIP code)
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Does applicant own property in any other If yes,what county? • What Taxing District? K
county in Indiana? ❑ Yes ❑ No /
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COUNTY AUDITOR
Deduction approved in the amount of. $9 ////��I
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20 20 20 20 20 20 �/(q� I - _ _
Signa of Courny Auditor a! County Date(math,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.
` Signature(o ha hems) ;.2 7 ( Date(month,day,year)
'/[1 WI resident address of eppfcant m/f/�rand/r dry,rind ZIP code)
Person a/r by duly executed Power of or by 6:1.1-12-01 C a I TA) ���� Date(rtronth,day.year)
Address of authorized person (number and street.city,state,and ZIP code) .