HomeMy WebLinkAboutMortgage_Larkins s, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
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• "vim; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Rresoibed by Department of Local Government Finance .
INSTRUCTIONS: '•'
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lb be filed in person or by mail with the County Auditor 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 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12)months JU t IBC
before March 31 of each year the deduction is sought - Lounty Recorder
See reverse side far additional instructions and qualifications. agar-
Ap r or/c�ont railpyV 1- on reverse sidM d GIBBON COUNTY AUDITOR
Ta istrict K number/legal description R enM��-a-a fI ace number —
a6�,_,3a-303- iloo-$b3-OD\ /4 ayy9 •
Assessed value of real property as of Mortgage/Contrail indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applcant the sole
Mardi 1,anent year March t year date of application legal or equitable owner?
,J1 h•J~-l/JC4T/ ❑ 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 dfterent than that of applicant.Indicate below Is the property in question:Annually Assessed
❑Real Property ❑ArmuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and;tree ' ,.sate,and ZIP code) f11r,,1,IW0_►_I_�`-"Y�`
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,o%state,and ZIP code)
Does applicant own property in any other If yes,what county? . What Taring District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current year.? ❑ Yes ❑ No •' COUNTY AUDROR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of Canty Auditor • County Date(month,day,year)
I/ ^ certify •er the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
■ r/con,.ct bu yntllie aforementioned property on date application is filed.
Sign ' - (o yi full n-,�Ve)) Date(month,day,year)
Full p!•r. - 1-x. .applicant(number and street,city,state,and ZIP code)
Person authorized by duly 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)