HomeMy WebLinkAboutMortgage_Jost (6) �La , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
j State Form 43709(R11/6-09) T
b�r Prescribed M Department of Local Government Finance �-'} 1 Eli
INSTRUCTIONS: j
Form Red with
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is locatedf EB 4 dog
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months ❑
before March 31 of each year the deduction is sought - •u n• -treader
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See reverse side for additional instructions and qualifications. r1'•rrllr
App5tln (ewre,ormnrrea¢,ye,-_ ,=sticti_„_sm reverse 'e) /1 D GIBBON COUNTY AUDITOR
District
LLIer. T �(/1'!l �AlG' l/O .36 ov- coo. x9 .2. -OO7 / 4 Page
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appraant the sale
Mardi 1,anent year March 1,artier date of application legal or equitable owner?
(/ O D ❑ Yes ❑ No
/
If no,what's his I 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: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
- Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller -r
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Address of mortgagee or contract seller(number and street,city,sate,and ZIP code)
—
Name of assignee or other owner or holder of mortgage --1 US I �� `•
Alec. Ru 3
Add T o/assignee(nusmber E and street 3tosa ,3 an d ZIw P cde)
4,5„
I{— I N N
Does applicant own property in any other If yes,what county? • What Taxing District? I
county in Indiana?
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 ,/ 20_ 20 20 _ 20 20
Signor •
s i'tnL/ 1i County Date(rmEh,day marl
�Yrt.tz./li
•
I 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/contact buyer of the aforementioned property on date application is filed.
kSignawre rY fug name) Date(month,day,year)
�FhA rrsa�of app! (number and street oily,sate,and ZIP code)
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Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-07 Date(month,day,year)
Address of authorized person (number and steel,thy,state.and ZIP code) •