HomeMy WebLinkAboutMortgage_Rich . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County
f. I
4 _ _. Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
12 State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. O F' S:V: 13 Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought County Auditor
2)Mobile/Manufactured Homes rat assessed as Real Property Must file during the twelve(12)months before March 31 of each year the deduction is •sought ' % it
See reverse side for additional instructions and qualifications. GIBBON COUN AUDITOR
Appbcant(o4wner��—o�r}jcon� ct tra4 4bu�yer-see restrictions an reverse side)
Ta. • it[strict Key /legal dews n Record number Page number
• w a& 9_ woo -ooa . a9q -Doti/ ao (3 y --7q6
. „1_,..,..value of real property as of Mort gage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
1,ass e rt yea March 1,o rrenD/ I:1 year date of application legal or equitable owner?
77 00 0 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than a vvr-e,indicate with whom
If name on record is afferent than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑AmtuallyAssessed
. Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller number and street. ,state,and ZIP code) -
Name of assignee or other owner or holder of rrortgage O ii
Address of assignee(number and sneer,city,state,and ZIP code) a
Does applicant own property in any other If ....• _
pP Y U .what county? • What Tarring D's Card NO. •.••.....•..•..
county in Indiana? ❑ Yes ❑ No _
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Sigma ofi 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
X S`oowwnneeer I contract buyer of the aforementioned property on date application is filed.
` / 4 X' 1 [:��'�Z! i Date(month,day,War)
t W resident address of applicant(number and sbaet, state,and ZIP code) �1
n /o a gi 5 . Ct .2 so LJ te-r t ) e + Y '16, Li e
Person authorized by duly executed Power of Attorney or by IC 6-7.1-12-0.7 •I Date(month,day,year)
Address of authorized person (number and.street city,state,and ZIP code)