HomeMy WebLinkAboutMortgage_Hull (3) r , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
. =;• FOR DEDUCTION FROM ASSESSED VALUATION
ACT State Form 43709(R11/6-09) •
am, Prescribed by Department of Local Government Finance
INSTRUCTIONS: I
To be filed in person or by mail. Form filed with
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought MAY 0 1 iA_
MUSt be Wed With the County Auditor or County Recorder of the county where the property is located ounly Auditor
on or before January 5 of the immediately succeeding calendar year. ❑ County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of th-j
county where the property is located during the twelve(12)months before March 31 of each year rm deduction is sought.
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See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Ap cant(owner or tract buyer-seeem�'Lions on memo side)
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T t Key num /legal description ( / to /d /y �(i (s5
c£ yli/i7�- B hxGn_ 2E5-,,,, f/zi.✓ ` CXOJ� IPa/!)A
Assessed vet to of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage unpaid applicant the sole
March 1,current Pai rtgage/ContmU indebtedness un d as of Is the
year M 1,current year date of application / legal or:qui a owner?
Oc 74 5-96 . G U 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 is different than that of applicant,Indicate below: Q(/ Is the property in question:Annually Assessed
• o?b-11-1 c!-30o - c9oa. r� 5J,-Da � �Property ❑AnnuallyAscesvd
Mobile Home(IC 6-1.1-7)
N�°of mortgagee or contracts er may/
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Address of mortgagee or contract sellerner ands ry,state,and ZIP / - -
?CO s. co )W/17rL /lit/!^- ',c�r� / hcrr/�iL £IEz2? .oi ;✓,i/O4i.5:_ i S`6,az/
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 / 9 If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? _
❑ Yes 1• No for current year?
❑ Yes
COUNTY AUDITOR
Deduction approved In the amount of:
20 20 20 20 20 20 20
Signet re of County Auditor County Date(month,day,year)
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/.. -ct buyer of the aforementioned property on date application is filed.
Si9na. s fu(1ranee)
Data(month,day,year)
Full 'dent address�p cant(num d street,city and ZIP code)
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Person authorized• duly executed Power of:..mey,.-C 6-1.1-122=.'I Date(month,day,yea)
Address of authorized person (number and street city,state,and ZIP code) -
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