HomeMy WebLinkAboutMortgage_Collins . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS my Township Year
FOR DEDUCTION FROM ASSESSED VALUATION IL
1 State Form 49709(R11/6-09)
Prescibed by Department of Lod Government Rance
File Mark
INSTRUCTIONS:
EP 1 3 2013
lb - -
be filed in person or by mail with the County Auditor or County Recorder of the county whe a property is located. Fomn Ned
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file dunny �o>onths
before March 31 of each year the deduction is sought. - ❑ County Recorder
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Applicant(mrvr rorcon . buyer`-ssylee=Motions ary{e � .�C9/
Ta>an9G pt, t�/U � 1!/fil 1 2c-0 r5 a 5 O d in ao a). a 9 9 0/e Rem% /her Pape 4/7 41
Assessed dvaavadcue of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the superant the sole
Mends 1,anent year March 1,m t year date of application legal or equitable owner?
�5 600 0 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with sc
If name on record is different than that of applicant,indicate below.
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Name of mortgagee or omen seller
ont • 0. :
Address of uawnyay,..,or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage O L I) 0A fsi i / _
Address of assignee(number and street,city,state,and ZIP code) r+�`-1 A p,IL
Does applicant own property in any other If yes,what county? • 6Vhat Taxing D -BA
marry in Indiana? !u❑ yes ❑ No
CP
11
IP 47,,t,2[_, COUNTY AUDITOR �D) �� J
Deduction approved In the amount of
20 20 20 20
I j.....--11 7 6(7
Signature of Canty Auditor • County
I I We certify under the penalty of perjury that the above and foregoing information is true
owner I contract buyer of the aforementioned property on date application is filed. •
Slgrowners h/A name) _
Fug resident of applicant(number and sneer,city,stale,and ZIP code)
kSyzv,cJ >s s PAToiiief s.✓ y7G6 6
Person authorised by duly executed Power of Attorney or by IC 6-1.1-12-0.7
Address of authorized person (number and street,city,state,and ZIP code)