HomeMy WebLinkAboutMortgage_Mizeur ra STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
-, State Form 43709(R11/6-09)
Prescribed bed by Department of Lo Government Finance '
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INSTRUCTIONS:
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To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. JA\7E2 g4
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Re during the twelve(12)months
), e
before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
1(owner or contract buyer-see restrictions on reverse side) GIBBON COUNTY AUDITOR
T Key taunt /legal d ' lion Record number Page number a , • 8-0/ DI ,�oi3 6 , o p
Assessed vdue of real popertya of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applcant the sole
Mardi 1,current year March 1,current year data of application legal or equitable amen
2-0e, coo ❑ Yes 0 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: -----^•won:Annually Assessed
Name of mortgagee a contract atract seller ) f(,720J CO
)( 1111I 1
Drawer l\' c)Jrl.�j� ,........
Address of mortgagee or contract seller(n and saes;city,state,and ZIP coda) �.
Name of assignee or other owner or holder of mortgage Card NO l•w.7......'
Address of nee(number and street,city,slate,f ZIP code) Ae'rr /
Does applicant own property in any other If yes,who nty? • What Taxing District? 'Has this deduction been requested on property I -
county in Indiana? ❑ Yes CI No for awed year' ❑ Yes El No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature Canty Auditor - l/rJ ' \ County Data(month.day,Year)
I I We certify under the penalty of perjury Mat the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner f contact buyer of the aforementioned property on date application is filed.
ES( Sty 1 one me) / L Date(month,day,year)
FUII resident address of applicant(number a t,e1y,staterd ZIP code)
5Y/ s Zion ear De fire nclr
l-h, SN Y7170
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Darn(month,day,yea)
Address of authaized person (number and street,city.state,and ZIP code) .