HomeMy WebLinkAboutMortgage_Golden ,?,_ . STATEMENT
DEDUCTION Ill OF MORTGAGE S ES OR CONTRACT INDEBTEDNESS County Township Year
,�`'-'�' FOR DEDUCTION FROM ASSESSED VALUATION
State Fenn 43709(R11/6-09)
Prescobed by Department of Local Government Finance
File a
INSTRUCTIONS: wmn
b be filed in person or by mail ca
with the County Auditor or County Recorder of the county where the property is located. JlL [U 14
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought County Audi:or
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction a sought - � er
See reverse side for additional instructions and qualifications. GIBBON (;O UN TY q{)h ITO
Applicant 2r or buyer-see n reverse e) , 2
Taxing District pA +ay number/legal description Record number Page number
fl J
a .o.tCat k a(0 • l4-It-3O on �
- n Lot a c1
sl I 2r-a
Assessed value of real popery as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,suers year Mardi 1,current year date of application legal or equiaole owner?
"1 'in a 9 Yes ❑ No
es
If no,what Is his f her exact share of interest? If owned with someone other than spouse,indicate with whom T
If name on record is different than that of applicant indicate below. t/ytss..,,thher�e property in quest:Annually Assessed
Property ❑Annually Assessed
TT
Mobile Homeiica-'---
of mortgagee or contract sal er ---
1� _t. - - !` A--=- - I 8°C'(o(°`{ab�
Address of mortgagee or contact er(number and street,city slate.and ZIP code) 1 ' (� �I a I
Name of assignee or other owner or holder of mortgage ^ ' — to• i�Jfr (C•.�J J
Address of assignee(number and meet c4Y,state,and ZIP code) I '
Does applicant own property in any other If yes,what county? I What Taxing Dist' O
county in Indiana? ❑ Yes ❑ No O/
bYulcooa
COUNTY AUDITOR \
Deduction approved in the amount at ' ^` ,4 .- O 55
20 20 20 20 20 I, OC)IIJI^ Jv
Signature of County Auditor County II ry /�+3Q
I!We certify under the penalty of perjury that the above and foregoing information is true and corn u�
owner/contract buyer of the aforementioned property on date application is filed. 1 --� Y a
le/ u�i,-4 4/,Hoye)� Date(nwuh,day,year)
F resident address of appficant(number and atree city,state,and ZIP code) ? r
kto 3Z9 w .Dil/isi o7J ST ()A kL4r�2 `L4 L7.b4v
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)