HomeMy WebLinkAboutMortgage_Hill (6) �.7 . FOR DEDUCTION FROM ASSESSED VALUATION
ATION INDEBTEDNESS County Township Year _
P-. 1.. State Fonn 43709(R11/6-09)
Prescribed by Department of local Government Finance
IleM D
INSTRUCTIONS:
RI be filed in person or by mail with the County Auditor or County Recorder of the county where the property is locat .
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. County Auditor
2) Mobile/Manufactured Homes not as<essed as Real Property:Must file during the twelve(12)months O T O ?D f 0 Recorder
before March 31 of each year the deduction is sought - tY
See reverse side for additional instructions and qualifications. n. _
Ap t(owneror contraci0 r-7 res�bon" s chi" e) 4 `�llf0/
rCJn�, 9( r/�v�^ [P A{/cieCA/' GIBBON COUNTY UDITOR
Ta istryt number Key number/legal desaiplion - Record numb Page number
/'--,0 4-4.C i✓ ;.la - is -0 7 - ?-•o t-/ - 00 3 . 3o/ - o of $ c)—o l3 '-I-4.z3-
Asesed value of real pmper•,y as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1,a>rrent year March 1,current year date of appficatbn legal or equitable owner?
S oO0 ❑ Yes ❑ No
If no,what a 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 apploan4 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 umer/� e
Address of mortgagee or contract setter(number and street,city,srAtp,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number sorest.city,.3ate,1/Zr�aldey,L - - —
Does applicant own property in annyyoother 3 r(/If yes,what county? - What Taxis'
county in Indiana? ❑ Yes
❑ No 0
COUNTY AUDITOR v) '1\\.e1• ~Q,••• ��
Deduraon approved in the amount of •.
Card NQ. ......•l•..... —
20 20 20- 20
Signature of County" -- _ /v ' ' - County -._,..ar,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 filed.
'\ Signature(owner's lull name) Date(month,day,year)
%3 S M.,�
t,Full resident address of applicant(number and street,city,state,and ZIP code))
t.!' ,. Szt ,.ii2tr.t-- -yam r-//!t/ 4/7—'r7
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 / Date(month,day,year)
Address of authorized person (number and steel,city,state,and ZIP code) .
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