HomeMy WebLinkAboutMortgage_Schmits (5) Eye: STATEMENT OF MORTGAGE OR CONTRAC DEBTEDNESS County Township I Year FOR DEDUCTION FROM ASSESSED VALUJ IL g�
_' f' FOR
eFaD 43709(R11 g' LgHJ
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: OCT 0 8
O
To be filed in person or by mail with the County Auditor or County Recorder of the county where eprO Form
perty is located. _mad
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought rLt7]/Cp inty Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly M�f7e dunn the )months
before March 31 of each year the deduction is sought. N°f I ❑ County Recorder
GIBBON COUNTY AUDITOR
See reverse side f r addifronal�in's/t�ructiat/sand
Q q�ua,,li�_fiQ'c�pa�t\iTo�ns. r,►�1�-1�/y� �j/�/
Appbrant(owner
�VaY 30.- 1 `a) �' / / n do•
Ta District number,legal dgka0- /9- ' a - al) -001.980—oas number 1- Page.-) as 7
Assessed value of real property as of Mortgage//`J,/Contract indebtedness unpaid as Mortgage/Contract indebtedness unpaid as of Is the applicant the site
March 1,arras year March 7,dnrtent n date of aPPrication legal or equitable owneR
Qc OHO ❑ Yes ID 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 different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Propertv_.El a^^•-"--c--
Name of mortgagee or contract seller +I ` 1-7)
II
A Address of mortgagee or seller(number and street,city state,and ZIP code) ll)'a vc C 1- NO.--
Name of assignee or other owner or hider of mortgage
—tea....
Card NO. •••• .•
Address of assignee(number and street city,state,and ZIP code) 1
Does applicant own property in any other If yes,what county? • What Taring District? Has this deduction been requested on property
county in Indiana? n
I:1 Yes ❑ No for current year?
❑ Yes ❑ No
I COUNTY AUDITOR
Deduction approved in the amount of:
20_ 20 20 20 20 20 20
• Sigma Cam iiw D fl - County Date(nlorth,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(o a hit name) Date(month,day.year)
tifirete et newt D
W en address of a number and street,city,state,and ZIP code)
6-03/E 57ss e'er-3#-tie-IX -
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street-oily,state,and ZIP code)