HomeMy WebLinkAboutMortgage_Baize (2) STATEMENT OF MORTGAGE OR CONTRACT TtEtT) County Township Year
FOR DEDUCTION FROM ASSESSED VAL T
,!'- f i State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance •
INSTRUCTIONS: JUL 25 2014 File Mark
Form filed with:
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the prope is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is h{. County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property.M elve(12)months
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications.
GIBBON COUNTY AUDITOR b
Applicant(owner or co'nn'trraacct t buyer-see on reverse side) /� TI
iaiDistrict`� / Key l esrnptnn �1 / Y' d number Page number
Y a,b7nn R to-//= a/-L306 CV 1/. ji 7 3 -Ch27 «C/// /// 263✓
Assessed value of real as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appfrant the sole
March 1,current year March 1,cvnentt date of application legal or equitable owner?
'7el 6Of ❑ Yes ❑ No
If no,what is his l her exact share of interest? •J If owned with someone other than gvv.m,indicate with whom
If name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
I Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller :4" I
Address of mortgagee or contract 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 Taring District? I u- ten requested on property _
county in Indiana? ❑ Yes
❑ No 6Az- ❑ Yes ❑ No •
-
Deduction approved in the amount of'. " Itb l
20 20 20 2t Q,YS1 Z
CN �3j I 20
Signature of County Auditor • ,,,northt day.year)
I
I/We certify under the penalty of perjury that the above and foregoing info, '.erect and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application it
Sigoe (�/u(t ) / Date(month,day,year)
G(
Full resident address of appGant( mu ber and ,c t,dry,state,and ZIP code)
soV3/ r i 0 2 o o s D o,t e P t i vJl c- -LW Y 7 6 Co \I--
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 dry,state,and ZIP code) .