HomeMy WebLinkAboutMortgage_Neukam STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION I —
I State Form 43709(R11/6-09) _
Prescribed by Department of Local Government Finance
INSTRUCTIONS: • _1. r.�
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.) onn led
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months I C T 3
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications. •
Ap t(owner o.contract twee restrirDOns on reverse side)
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J /��/9L GIBBON COUNTY AUDITOR
T District Key number desalt]' Record number Page number
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Assessed value of real property of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness'unpaid as of Is the applicant the sole
Mardi 1,current year Mardi 1,anent year data of applcalion legal or equitable owner?
(/F 5 yo I ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate icate with whom
If name on record is different than that of applicant,indicate below-. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
I Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller _ 26C1/2
Address of mortgagee or contract setter(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage � ) I/�c �'/J, /�
Address of assignee(number and street,ray slate,and ZIPyadeL D_17.-i< S/ /ir r- / i y rL
Does applicant own properly other V If yes.what county? • What Taxing District?
�s^^e�m J�'SHu�
county in Indiana?
❑ Yes ❑ No
/3 -30 /
COUNTY AUDITOR
Deduction approved in the amount of: •
I
20 20 20 20 20____ ---.20 'cu
Signature of County Auditor x • County Date(month,day,year)
4
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.
nature owners ht re Date(month,day,year)
-sin,( rli.9_ loJ tJza m,
VFull a address Z applicant(number and street,city,state,and ZIP code)
p g2.2_ Wr'S-t A . Oak land ea /7(4 , (0n Le7Lo(on I
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,and ZIP code)