HomeMy WebLinkAboutMortgage_Stevens STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
" :*ta Fit FOR DEDUCTION FROM ASSESSED VALUATION
' State Form 43709(RU/6-09)
Pre a1bed by Department of Local Government Fiance 1
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•INSTRUCTIONS: • i :..
To be filed in person or by mail with the Court Auditor or County Recorder of the county where the property F• �• `
County h P PertY is located.
Filing Dates: 1) Real Properly.Must file during the year for which the deduction is sought [[R� pC�o9unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months DR L(t�]t,t n�'v J�
before March 31 of each year the deduction is sought. - i_�I mL 3co u
See reverse side for additional instructions and qualifications.
Appfica 11. or contract buyrsee ms - "ors on reverse side)
r , GIBBON COUNTY AUp n
Tau-. •istrict . number/legal description Record number Page
iY / / o7�_ aD - pa - 'foq - 000. .3a, i - oc�,3 01013 j 4'
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applcant the sole
March 1,anti year March 1,ax t /` data of appicetlun legal or equitable owner?
20 (D/ CI ❑ Yes ❑ No
If no,what's his/her exact share of interest? f If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant indicate below: Is the poperty in question:Anruauy Assessed
❑Real Property ❑Annually Assessed
• a \ Mobile Home(IC 6-1.1-7)
g or Name of mortgagee contact seller 0
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 street,city,state,and ZIP code) /S
Does applicant own property in any other If yes,what county? . I What Taxing District D 1 `l„ C t- `\ ••••••..
county in Indiana?
❑ Yes ❑ No
Card NO. .. •• _
COUNTY AUDITOR _
Deduction approved in the amount of
20 20 20 20 20 20_ 20
Signet re g of County At{dtmr l County 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/contract buyer of the - ed property on date application is filed.
Sigma Date(month,day.year)
/�
all reed address applicant(number and street any,state,and ZIP code)
/0 36 o7 £. fil/9-Z/1./ 5rr t ,44511s'D eyry -Z/z/ s// 0
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of audror¢ed person (number and sboe4 try,state,and ZIP code)