HomeMy WebLinkAboutMortgage_Gonzales .. -- 'r STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Goun Township Year
` '.;
r.' ., FOR DEDUCTION FROM ASSESSED VALUATION ��-
�� State Form 43709(R71/6-09)
ozo Prescribed by Department of Local Government Finance ti rat
. INSTRUCTIONS: Ile '■•r ,p;•
To be filed in person or by mail. Form fled with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought. 2r�3-�I
Must be filed with the County Auditor or County Recorder of the county where the property is located S P 4-i1 Z(baunry Auditor
on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the ' , �i
deduction is sought �I°►flh
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Applicant(ovmer or contract buyer-see resNctions on reverse side) .
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Taxin / Key nu /legal description Record numbe Page number
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Assessed vahie of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal at equi hie owner?
/ V 3. 22° des ❑ No
If no,what is his I her exact share of erest? If ovmed with someone other than spouse,indicate with whom
Wo- 13-I 1-400-OCO4yd-Doki
It name on record is different than that of applicant,indicate below Is the property in question:Annually Assessed
--
eal Property ❑Mobile ome(IC n 61.1-7)
Name of mortgagee or contract seller/ �J
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Address of mortgagee or contract seapr(number and street,city,state,and ZIP code) ,,i / -
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Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,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 far current year
❑ Yes E No
' COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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/contract buyer of the aforementioned property on date application is filed.
Signature( r ➢name)
Date( tri,day year)
Fu I r ent address of.galivant(number and street,city,state,and ZIP code)
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Person authorized by duly executed Pourer of Attorney 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)