HomeMy WebLinkAboutMortgage_Creek a. . STATEMENT OF MORTGAGE OR CONTRACT 1 bounty Township Year
�La}}}f+111.��r',,����•,r;; FOR DEDUCTION FROM ASSESSED VALUATI
,"-ti5�,'J State Form 43709 Department l t 6-09)
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_"-- Prescribed by Department of Local Government Finance 1
File Mark
INSTRUCnONS: DEC 1 7 2013
Form filed
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: 7) Real Properly:Must file during the year for which the deduction is sough County Auditor
2)Mobile/Manufactured Homes not acsnssed as Real Property Must A 2)months
before March31 of each year the deduction is sought GIBBON COUNTY AUDITOR
El County Recorder
See rse_side for��yd�diiitiionneet ins VVV rrr///ctlons and qua!
lions.
i irr �/ X r ieslr�orrs on r@var1�ffie)�/,/ r �p
Ta ' District 41'/r'C.CY number/( al tlesrni 7 - o/ rxt act oa a o(0 13 Pa ge ryugper3^
Assessed value of real property as of Mortgaga//_Contract indebtedness unpaid as of Mortgage I Contract"indebtedness unpaid as of Is the applcanntt the sole /
March t,current year Mamh t,wrtentye/� f� date of apPrcation legal or equitable owner?
( ,1306 I ❑ Yes ❑ No
If no,what is his/her pact share of interest? if owned with someone other than spouse,indicate with whom
If name on record is ddferent than that of applicant,indicate below. Is the property in question:Annuary Assessed
• ❑Real Property El alt ally 6-1.1-7)
Name of mortgagee or contract seller �
Address of mortgagee or contract serer(number and I.city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.thy,slate,and ZIP code) -- nM �
Does applicant own property in any other If yes,what county? . V ` ratan been requested on property
county in Indana? ❑ Yes ❑ No Cll^ ��• �O aR
l3c3 )44 ❑ Yes ❑ No
COUNTY t
Deduction approved in the amount of: v _c30-0
20 20 20 20 20
.\ /.. ty clan ' !� County I I I Date(month,day,year)
II We certify under the pena ty of 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 pfofementioned pfroperty on date application is filed.
$7p an AhA I //_ I Date(month,day,Year)
FtA refideth address doff..^/. t ((nnuu(mbe rr and street,•'VN(aata and JI ,..e) I i
e_. . A ► I W. �r.► % _ r /N. 3 •S
Person authoraed by duty executed Power of Attorney or by 6-1. -t 4,- I Date(month,day,year)
Address of authorized person (number and sleet,dry,sere,and ZIP code)