HomeMy WebLinkAboutMortgage_Cooper (8) . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN pounty Township Year
FOR DEDUCTION FROM ASSESSED VALUATIr II�
t'( State Faun 43709(R11/6-09) J
Prescribed by Department of Local Government Finance
File Mark
INSTRUCDONS: AUG 2 0 2014
To be filed in person or by mail with the County Auditor or County Recorder of the co
Form coed
county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file du 2)2)months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Applicant mrrtrau buyer-sea resin me side
4 or(o-b -t-d�l OI-o op . I vo-Odd PT U
Assessed value of real property as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appfrcant the sole
March 1,current year March 1,cu nnt�{.. data a plcation f� legal or equitable owner?000 ❑ 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 applcant indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller n ,„
Address of mortgagee or contact seller(number and street,city,state.- . code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.dry,state,and Z , j Annan ("\• /+...,�__r->
Does applicant own property in any other If. i l�l/ \`I,1�7�LVl 1 this deduction been requested on property .
county in Indiana? El yes ❑ No Drawer N O..a0 urmnt year? ❑ Yes ❑ No
i 351<1 .
Deduction approved in the amount at. Car(1 l\r O.
M3a,toa C
20 20 2L,
II I 20 I 20
Signature Co try itor \CZSI/� County Date(month.day,year)
s
I I We certify under the e penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner co tract buyer of the aforementioned property on date application is filed.
.r i te-si 1 Date(month,day,year)
IV Full.t'..ent address of applicant num and street.rTy,state,and ZIP code) /r / //
ai /o S' gVoc2 � ly- i# /— el 2‘.644 so
Person authorized by duly executed Power of Attorney or IC 6-1.1-12-0. Date(month,day,year)
Address of authorized person (number and street,city:state,and ZIP code)