HomeMy WebLinkAboutMortgage_McGarrah ea.,. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;; FOR DEDUCTION FROM ASSESSED VALUATION _
" Slate Form 43709(R11/6-09)
Prescn'oed by Department of Local Government Finance
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INSTRUCTIONS: + i� .�.
Forth d...--o-
M be filed in person or by mail with the CountyAuditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought r ty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Re during the twelve(12)months yy
before March 31 of each year the deduction is sought. A R uny Recorder
See reverse side for ad•rtki instructions and qualifications. • il
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Applicant(owner or... .%I - .sea -% -,:. mravp tle) f r - II / �•
/ ' ` / ' 1 GIBBON COUNTY AUDITOR
Taring Di a6--►a—0 q- yo a- o(. qs?-oa `moo L/ Page
Assessed value at real property as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year March l Can date�r date of app&oarion legal or equitable ow+reR
�/`/h ❑ yes ❑ No
If no,what a his!her exact share of interest? H owned with someone other than spouse,indicate with whom
If name on record S different tun that of ape/cant,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 I
Address of mortgagee or contact 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)
Does applicant own property in any other If yes,what county? • What Tatting District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current year? ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved In the amount of
20 20 20_ 20 20 20 20
Signature of County Auditor 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 I contract buyer of the aforementioned property on date application is filed.
Signature(o-%' I name) Date(month,day,year)
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F I ,-'..ent-... of a.• i't(number and street oly,state,and ZIP code)
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city state,and ZIP code)