HomeMy WebLinkAboutMortgage_Eley (2) O SSSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS on Township Year
rriill FOR DEDUCTION FROM ASSESSED VALUATION State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: DEC 3 2013
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form Ned -
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Filing Dates: 1) Real Property Must file during the year for which the deduction is sought County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the Fire
before March 31 of each year the deduction is sought. - County Recorder
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Apo nl Spier oc buyer-see on reverse side)
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T D' Key ben/legal description Record number Page
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Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact'indebtedness unpaid as of Is the apparant the sole
March 1,current year March 1,ohm date of appaptign legal ❑
(7J ❑ 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,indicate below: is de property in question:Annually Assessed
Real Property ❑Annually Assessed
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Mobile Home(1C 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city state,and ZIP code) •
—
Name of assignee or other owner or holder of mortgage L cii12/3u2 a
L EV
Address of assignee(number and street city state,and ZIP code)
Does applicant own property in any other If yes,what county? • What 1 operty -
county in Indiana? ;l
❑ Yes ❑ NO I�_ 1 S 75 ❑ No
COUNTY AUDG r� l/
Deduction approved in the amount of. •
20 20 20_ 20 20 20 20
Signature of County Auditor • 1 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 I contact buyer of the aforementioned property on date application is filed.
Sfgraarre(owns me)nn / Date(month,day,year)
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Full resident address applicant(number and street aly, -n =rid ZIP code)
"3 o 7 N. Gd.2-1 n/u cTT FeaT S/t z-h# IA/ Y7G�l
authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 r 'Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) -