HomeMy WebLinkAboutMortgage_Goldman i. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
fig Qs'disti FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09) -- --
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Pt Department bed by Department of Local Government Finance
:
Taft it,
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INSTRUCTIONS: 1 -
lb 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. Co
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months i Z'I, ry editor
before March 31 of each year the deduction is sought - County Recorder
See reverse side for additional instructions and qualifications.
Applicant(o rr�or cart2a buyer-see restriction re std ) I
///��� /L/t(Y�1 ,� ,� ` " , � 'r ��tea /yy /►-� GIBBON COUNTY AUDITOR
Tee?0 ' Key number/ gal Record number Page number
`` al(0 -. 3 - aoo- Do a. 4QS-Da4 as i3 3CO7
value of real property as d Mortgage 1 Contract indebtedness unpaid as of ((Mortgage I Contract @Webtedneas unpaid as of is the applicant the side
1,artart year Marts 1,OO entylear
� _ date of apprxation I legal or equitable owner?
El
❑ 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 the properly in question:Annually Assessed
❑Real Property ❑Annually Assessed
—- 1 Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 1 /3� /
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) / ) /
D
5
rawer NO - L/
Name of assignee or other owner or holder of mortgage 1
Address of assignee(number and street dry,sate,and ZIP code) C`)l-(� NO. ��
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Does applicant own property in any other If yes,what county? What Tardng District? I Has thin decucoon peen i cut..t ,N,,,r,ety
county In ludara? ❑ Yes ❑ No for artcol year? ❑ Yes
❑ No•
COUNTY AUDITOR '
Deduction approved in the amount of:
I
20 20 20 20 20 20 20
Signature of County Auditor - County I Date(month,day,year)
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. I
'attire
t r IW ramea J I Date 1,9_7-17-13
F(\J�/ I
II ant tip t number street oly,state,and ZIP code)
`CH. L. i�-�qc i &a
lion authorized by duty executed Power of Attorney or by IC 6-I.1-12-0. 4 I Date(month,day,year)
Address of authorized person (number and street ory,sate,and ZIP code)
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