HomeMy WebLinkAboutMortgage_Sherman (2) a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
r ; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709( t
Presmbed by Deparrnienoof local Government Finance
FILL ED
INSTRUCTIONS: I Form filed with: ..
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. ,(�
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought I ItiO`'oo'tlr{�Aig
2)Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)months (�
before March 31 of each year the deduction is sought - County Rem er
See reverse side for additional instructions and qualifications.
t(rnmeror contrciuuyer-_see`Creversesyde) I GIBBON COUNTY AUDI I Ui
T DiStruct �[��/ ��Y(/', Key number/legal description Record number Page number
4_,,,,24.4.170 o/lp -!a O9- /an-oo3. 33a - oa7 I aor -3 3ga -5
Assessed value of real popery as of Mortgage/Contras indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the apptoant the sole
March 1,and year March 1,current yee,42 O O date of app(vlion I legal ❑ Eowner?
l C..� � Yes No
/
If no,what is his/her exact share of interest? I If owned with someone other than spouse,indicate with whom
If name cc record is different than that of applIca t,indicate below Is the property in quesbau Annually Assessed
El Real Property ❑MnuallyAssessed
. I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller :51//3 l(number dress of mortgagee or contract seller(number and street city,state.and ZIP code) l
Name of assignee or other owner or holder of mortgage
Andress assignee(number and street city.state,and ZIP code) :II_
�7 w N 9- a - i o x. 190
Does applicant own property in any other If yes,what county? • What Taxing District? I Has th deduction been requested on property .
county in Indiana? ❑ No - coif __�� ❑ Yes ❑ No❑ Yes
COUNTY AUDITOR /^(/
Deduction approved in the amount of Dt a WYe r NO..(,.� O/
20 20 20 20 20. Card NO. _
Signature .41- rx..4—��7 • County
I/We certify under the penalty of perjury that the above and foregoing information is Due 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.
S nature(o hue name) Date(nmat day year)
it ,T, 1
WI t dress of Door(number and cry,state,and ZIP code)
•
C/ ►V Oft i�r. } (�rtCIZ n G J -l-llvl U
Person authorized by duty executed Power of Attorney or by IC er1.1-12-0.7 - Date(month,day,year) _ -
Address of authorized person (number and street city,state,and ZIP code) l