HomeMy WebLinkAboutMortgage_McKinney F . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
tats FOR DEDUCTION FROM ASSESSED VALUATION
Lam' ' 1-:] State Form 43709(R11/6-09)
�4�� i'7 Prescribed by Department of Local Government Fiance
INSTRUCTIONS: e����
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property Fgm)11 -
F7irtg Dates: i) Real Property:Must file during the `y N P Pedr is located. 1
ng year for which the deduction is sought. 'DEC County
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months Court Auditor
before March 31 of each year the deduction is sought
I PI .• ' ecorder
See reverse side for additional instructions and qualifications. ,' • "" i' - -
(owner contractb r-see re. verse side) GIBBON COUNTY AUDITOR
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Taxing Lelia Key number/legal desaip' Record number Page number
eU - /7-a: 2,00 — 004. say -o J-/ -oto(3 cot- no
Aj�ieal property I Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Mann 1, Me 1.cement year ^^ date of apprt ation I legal or equitable owner?
Q DG/ ❑ Yes ❑ No
If no what a his/her exact share of interest? t If owned with someone other than spouse,indkate with wham
If name on record is ddferent than that of applicant,Indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• 1 Mobile Honie(IC 6-l.1-7)
Name of mortgagee or contract seller 5/3
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sleet ci y state,antl�P code)
- w ereac / • Drawer NO I g0/6
Does applicant own property in any other If yes,what county? • What Taxing Dis
county in Indiana? ❑ Yes •
❑ No
Card NO. .&! O
COUNTY AUDITOR _
Deduction approved in the amount of.
20 _ 20 _ 20 20 20 20 20
Signature of County 'Data(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/contract buyer of the aforementioned property on date application is filed.
�(owners me) Date(nw+N,day,year)
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F (gent address o(appfranl(nom and street. (st`ate,and LP ) •7^ I /
7276 &) I1 og Ji (i— Ott/E4Jl./i/le —fs/✓, k2ur
Peen authoriz d by dory exeatted Power of Aiwney or by C 6Y. -12-0.7
Date(month,day,)ear)
Address of authorized person (number and street city,state,and ZIP code)
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