HomeMy WebLinkAboutMortgage_Banister STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
1.!.:- State form 43709(R11/6-09)
Prescribed by Department of Local Government Faience N li
f ii Mark' IMI
INSTRUCTIONS:
Form riled 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 N 0®2 4otlhditor
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.
Aver ` 1-or con , s DcrL On`a"efS GIBBON COUNTY AUDITOR
Taxi Istria Key number/I al description f91- Record number P e mamba
I
4. I 0)96 // / 4011090.3 / od�� I /3 ,,> .�Assessed•value of real pn xy as of Mortgage/Contract indebtedness unpaid as of ortgage I Contract indebtedness un March 1.avrent year March 1,current year ate of appica ? legal or applicant e owner?
Y ❑ 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 different than that of applicant,mdkaa below Is pioperty in question:Annually Assessed
���999 Reel Property ❑Mobile Y 6-1.1-7)
Name of mortgagee or contract seller /// n c, I
Address of mortgagee or contract seller(number(r and street,city,sate and ZIP code) I
Name of assignee or other owner or holder of mortgage
`7199 n�}
Ql� gd/ �31�
Address of assignee(number and street,cry,sate,and ZIP code)
Does applicant own property in any other If yes,what county? , What Taxing D - Has that deduction been requested on property .
county in Indiana? \n For atrlent K� ❑ Yes ❑ No
❑ Yes ❑ No �flr(f _ -
hl
COUNTY AUDITOR I C \ , .
Deduction approved in the amount of: Chits- \
y/�
20 20 20 20 - T /� `_/� .-
tI lU
Signature of County Auditor County •
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the i pplirant a_ r and
owner I contract buyer of the aforementioned property on date application is filed.
Signature •- tuff - J I Date(nxvuh,day,year)
Full - �.(n rah• aiy,state.zed r• ..._)
• authorized by duly executed Power of Attorney or by IC 6-1.2-12-0.7 I Date(month,day,yea)
Address of autivized person (number and street,city,slate,and ZIP code)