HomeMy WebLinkAboutMortgage_Leek . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t..,:
;; FOR DEDUCTION FROM ASSESSED VALUATION
-ti State Form 43709(RI1/6-09) $gyp
Prescribed by Department of Local Government France g j]
INSTRUCTIONS: d�-.�
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.A 11 p 2
Form ed with:
m 014.
Filing Dates: 1) Real Property:Must fife during the year for which the deduction is sought r i� H County Auditor
2) Mobile/Manufactured Homes not ass-seed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought - u ecorder
See reverse side for additional instructions and qualifications.
Appilam(owneror contract buyer-see to on re rse ' e) GIBBON COUNTY AUDITOR
Taxing District/.fin/_ )Key number/legal desoiption Record number Page number
a6 - /7 - o9 - aoo - co / y7 - . 1,0111/ 1,o � 1512'(
Assessed of real of Mortgage/Contract indebtedness unpaid as of Mortgage I Conoact indebtedness unpaid as of Is the applicant the sole
March 1, year March 1,current year data of application legal or equitable owner?
114j OOb ❑ Yes ❑ No
if no,what is his/her exact share of interest? If awned with someone other than spouse,indicate with whom
If name on record is dflatent than that of applicant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 0—, v
Address of mortgagee or contract seder(number and street,city,state.and P
Name of assignee or other owner or holder of mortgage
Address o�f assignee(number and street city, / 0 t� �'a}S'C'j• 1'`r
Does applicant own pro in any other If yes,what county? 'What Taxing Dist& ,..r ..../.5--- I
manly in Indiana? ❑ Yes ❑ No Card j`ro I / J
COUNTY AUDITOR L!
Deduction approved in the amount oft
./r/•
a220ne, 20 20 20 20 20 20 .
Sign of Counry Auditor • County Date(month.day,year)
�f�i/��7/`-c�/c!/,w
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 aforementioned
,/))ppproperty on date application is filed.
k, Signal , .n name) a/� Date(month,day,year)dress of
10 t number t r.o I.and'02�/Pmdeyt .i �� /� a „77‘945.....
\r\ Person authorized by duly exam ewer err Attor ey or IC 6-1..1-T2-0.7 (`f)•(/ l{r///V//iU/r Date(month,day,year)
Address of authorized person (number and sheet city,state,and LP code)