HomeMy WebLinkAboutMortgage_Mroz STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.t'•_r �J
FOR DEDUCTION FROM ASSESSED VALUA
%r" fi State Form 43709(R11/609)
Presnibed by Department of Local Government Finance
File Mark
INSTRUCTIONS: SEP 6 2013 Form Bled wipe
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. r,
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. Icy County Auditor
2) Mobile/Manufactured Homes not accessed as Real Property Must fir ring th 2)months rLyt•J'
before March 31 of each year the deduction is sought County Recorder
Sae reverse side d'" nalinstructionsandqualitiactions. GIBBON COUNTY AUDITOR
Applicant(owner con on,� �fselsb
Key nun /IegaV I/d lesaip/)luon•L/l` Recd mt Page number
� i alb—/a/� a/ l oi3 yEGI a
Assessed value of real property as of Mortgage/Conbg6gF�debtedness unpaid as of Mortgage l Contract indebtedness unpaid as of Is the applicant the sole
Math 1,arrant year Mardi 1,omenQe�/J X70 ^ ^ state of aPP�Cation legal ar equitable on+reN
LJJ(OY /vHIJ/ ❑ 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 record is afferent 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 !�
Address of mortgagee or contract seller(number and street, .state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,my.state,and ZIP code)
Does applicant own property in any other If yes,what county? . What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current yeah ❑ Yes ❑ No
___ _— COUNTY AUDITOR
Deduct. /�
20 Drawer \0..9.1I
.3... 20 20 20 20
S7natur. /�''1' Q� County—C�g Li 11� ,� /1 Date(month,day,�ear}i _0( //s
Card NO L„!�» /,,f///`-^/(,�I/drafo {I\Vl b
I l v iegoing information is true and correct and that the applicant is a resident of Indiana and
owne application is filed.
nature tvweers am na ) Date(month, y,ye
ii41 resident address of applicant number and eL�yy���qte,and ZIP code
11 Oa SS D oil 1`1a,�1, 5{ , eMc�.1) J ) '{; (90
authorized by d executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day:year)
Address of authorized person (number and sneer city,state,and ZIP code) .