HomeMy WebLinkAboutMortgage_Miley (6) r STATEMENT OF MORTGAGE OR CONTRACT INDEBTE NE ounty Township Year
FOR DEDUCTION FROM ASSESSED VALUATIONN' T
State Form 43709(R11/6-09) it • 1 -� 1
•
Prescribed by Departrnerrt of Loral Government Finance t •
File Mark
INS7RUCTIONS: DEC 2 6 2013
Form teed with:
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: 1) Real Property:Must file during the year for which the deduction is sought. .,
2)Mobile/Manufactured Homes not assessed as Real Properly / ' �) County Auditor
party:Must file du th' months
before March 31 of each year the deduction is sought County County Recorder
See rev ' 0 for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Ap buye -see reverse side)
Ta District Key number/legal description Record number Page number
a6- -,8 -aoo - a•/3o -6o / I a0',3 446Y
Assessed value of real property as of Mortgage/Contract" ness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appbcant the sole
March 1,anent year March I,current ....., of appam6on legal or equitable owner?
coo 1 ❑ 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 S different than that of appltant.indicate below. Is the pmpenty in question:AnnualyAsses.ed
❑Re h I Property ❑ Assessed
ssessssed6-1.1-7)
•Name of mortgagee or contract seder
Address of mortgagee or contract seder(number a street,chy,slate.and ZIP code) —+ --
Name of assignee or other owner or holder of mortgage
Drawer NO:CPD./2
Address of assignee(number and street my,state,and ZIP code) I • '
Does applicant own property in any other If yes.what county? What Taxing District? Card NO teal
(/rte/!•.
county in Indiana?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved In the amount of
20 20 20 20 20 720 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 uue and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the -mentioned property on date application is filed.
Sigrewre(��. I Date(month,day,year)
/2-/..26/zap
t- o :.. .- t( . rand street ary,state,and ZIP j
to ( 2[ E ! -0 5- Fi- /.56794.cog , /.✓ 1474 ye I
•_i authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)