HomeMy WebLinkAboutMortgage_Karcher STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
: FOR DEDUCTION FROM ASSESSED VALUATION
State Fern 43709(R11/6-09) �
Prescnbed by Department of Lod Finance ance I lie E /
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INSTRUCTIONS: JJLL ��/
with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form Med
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. 0:1- [ ra:gray Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications. QA fu
^p7°'""er0fO0"y°�����eJ y J ) GIBBON COUNTY AUDITOR
T ' DDisuict�ua•1 K' Key number I description /``' •t/LJ Record number Page number
o2(o - a3 -o/-d0o _poa. /75 - 0 >1- V 1013 VY ?-6
value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Marra 1,current year March 1,extent year date of application legal or equitable owner?
Iio0y oo0 ❑ Yes ❑ 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 efferent than that of apperant hdicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
- �(/'Jl Mobile Home QC 6-l.1-7)
Name of mortgagee or contract seller / /l/ n
—
Address of mortgagee or contract seller(number and street city,state,and ZIP code) /J
Name of assignee or other owner or holder of mortgage NO
j
Drawer O
Address of • narMS�4drY.state,and ZIP COde) / ,,
. lLll a 3 Card NO. ...,. `T.,...Y:..
Does applicant own property in any other If yes,what county? • What Taxing District?
county in Indiana? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved In the amount of
20 20 20 20 20 20 20
Signs red 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/contract buyer of the aforementioned property on date application is filed.
XSig woerS name / Date(month,day.year)
Put dent add of I(number and street city,state,and ZIP code) /
1 0(n1 e ) OSO s il nubsfnfi-i' Sou) rh7(n39
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 street city,state,end ZIP code) .