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HomeMy WebLinkAboutMortgage_McKannan (3) . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year 1< er`.t FOR DEDUCTION FROM ASSESSED VALUATION �"` ■ e State Form 43709(RIO/11-08) Gibson Center '1/471 - " Prescribed by Department of Local Government Finance �, INSTRUCTIONS: i Fir- . a 1 ; To be filed in person or by mail with the County Auditor of the county where the properly is located. Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)month re March 31 of each year the deduction is sought. I 4 Z013 See reverse side for additional instructions and qualifications. /� Applicant(owner or contract buyer-see restrictions on reverse side) -l f[ Jace D. McKannan GIBSO+1JpCOUN Y AU TOR Taxing District Key number/legal description I Record nu age number Center 26-13-28-300-001.598-004 / — ok9 3 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,cement year March 1,current year date of application legal or equitable owner? 96715.00 © Yes ❑ No If no,what is his/her exact share of interest? K owned with someone other than spouse,indicate with whom n/a It name on record is different than that of applicant,indicate below: Is the properly In question:Annually Assessed ❑Real Property p Annually Assessed Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller Wells Fargo Bank, N.A. Address of mortgagee or contract seller(number and street,city,state,and ZIP code) 1 E.22nd St.,Suite 600, Lombard IL 60148 Name of assignee or other owner or holder of mortgage Address of assignee(number and street city,state,and ZIP code) Does meppgmnt own property in any other �/ If yes,what county? What Taxing District? Has this been requested on property ❑ Yes LVJ No ❑ Yes ❑ No COUNTY AUDITOR Deduction approved in the amount W: 20 20 20 20_ 20 20 20 Signature of County Auditor County Date(month,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 fled. Signal° owner ep e Date(month,day,year) rrresde'ta2�A!/ , 09/26/13 F F resident address applicant(number and st city.state,and ZIP code) i 3cD5i' imnt fr� 5 73©1 Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day}rear) Address of authorized person (number and street city state,and ZIP code)