HomeMy WebLinkAboutMortgage_Sives c-._. _.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION T
State Form 43709(R11/6-09) ga
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scribed by Depaent of Lo Government Finance ED .
MI
INS7RUC77ONS: Fprtvhigad,y4tp
lb be flied in person or by mail with the County Auditor or County Recorder of the county where the property is located.JU G J1 � ;':a
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought u County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must rile during the twelve(12)months 7
before March 31 of each year the deduction is sought - , • r �r°' • -emrder
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See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Applicant(o•ner or contract buyer-see resbirtiov)
Taring District Key number/legal description Record tuber Page number
D 24 - /w /g- ?Of- 000. 7 / 6 - oo 7 7 02 ad-s
Assessed value of real pronely of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as k is the applicant the sole
March 1,anti year March 1,9.pient year date of application legal or equitable owner?
DO ❑ Yes ❑ No
If no,what Is his I her exact share of interest? f If owned with someone other than spouse,indicate with whom
If name on rend is different than that of applicant indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed 6-1.1-7)
• Mobile Horne(IC Name of mortgagee or contract seller mpr• _
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Address of mortgagee or contract seller(number and street city, V.and ZIP code) 11/t3 / • /Q-
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Name of assignee or other owner or holder of mortgage
Address o assignee(number a street cdlc state,and ZIP `../ r� Pr/ y// l 00?1/45
Does applicant own property in any oU 'Eyes,what county? What Taxing District'
minty in Indiana? h
❑ Yes ❑ No ,
COUNTY AUDITOR
_
Deduction approved in the amount at
20 20 20_ 20 20 20 20
Signature County Auditorc ' ,//_/ t• -y County Date(month,day,year)
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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 property on date application is filed.
-- (owners fug name) ,ryI 2 , Date(month,(month,day,year)
r\ (owners
p• XK�-C�/ CG
.\--FuP resident add of fuant(number and sheet,city,state,and ZIP rode)
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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) .