HomeMy WebLinkAboutMortgage_Evans (2) , . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township j Year
qc`���+-� FOR DEDUCTION FROM ASSESSED VALUATION
1 State Form 43709(R11/6-09)
Presmbed by Deparbnent of Lmcal Government Finance ark .
INSTRUCTIONS:
To be Red in person or by mail with the County Auditor or County Recorder of the county where the property R 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 Re during the twelve(12)months SE 2 & er
before March 31 of each year the deduction is sought Co
See reverse side for additional instructions and qualifications. _
Appfiam((oo7r or contact buyer-see =moms on reverse see)
GIBBON COUNTY AUDITnR
�T number/legal desaiptirn Record number Page number
,A_ Key number - o - a3 - 3o0_ 000. ( 90 .0/ �j ?,otci 37o8
Assessed value of real property as of Mortgage/Contra=indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,arrant year March 1,current year date at a legal or coo able owner?
.�'5 9 0 0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whore
If name on record is different than that of applicant.indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile h4+n°fir" _
Name of mortgagee or contra=seller -
s8 $5101 ate ....
Address of mortgagee w contra=seder(number and t,city,stale,and ZIP code) ..•...
Drawer \O•. (j
Name of ass ee or other owner or holder of mortgage 57 O]S........
Address of assign number and street,city.a and VP cede) Card 0• .••••••••• C�!
IT 5 w a 3 / -// /AC clul &ICLNiCI
onprry
Does applicant cum property in any other If yes,what county? What Taxing Dater .
county in Indiana? I
El Yes ❑ No
for curt year? Yes ❑ No
COUNTY AUDITOR -
Deduction approved in the amount of:
20 20 20_ 20 I 20_ 20 20 .
Signature of County Data(month.day,Year)
I I We certify under the penalty of ppe_i ury that the above and rum-going 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.
"C Slo ague wars ) Date(month,day,year)
C
ua resident I apprrant(number and street,a ,state,and ZIP cod ) �,b Co 3(000 tJ ,s pfitokA r r C Co
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month.day,year)
Address of autt ns i person (number and street city state,and ZIP code)
•