HomeMy WebLinkAboutMortgage_Johanningsmeier a.. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS �Au Township Year
v>4 FOR DEDUCTION FROM ASSESSED VALUATION g1(
', 1= State Farm 43709(R71/6-09)tm g / � - _
Prescnbed by Department of Local Government Finance g IT
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File Mark
INSTRUCTIONS: SEP 3 0 2014
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form toed with:
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the (12 flsl
before March 31 of each year the deduction is sought - U.P County Recorder
See reverse side for addiitionalinstructions and qualifications. GIBBON COUNTY AUDI",OR
Apr...— .(owner or " 'sill an reverse side)
Taxi . r•— • numbs/legal description 'Pagentmhbar
,�- 1-��-3 X40 coo 10 00 9 7 /Yo
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app rant the sole
March 1:harem year Magri 1,current date of application legal or equitable
t 010 Yes D No
If no what Is his I her exact share of interest! If owned with someone other than ywmn,indicate with whom
If name on record is Ntferent than that of applcunt Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annua*yAssessed
• • Mobile Home QC 6-1.1-7)
Name of ee or seller
r ..Ck-.fi -
Address of mortgagee or contract seller(number and street,ay,stam,and LP code
Cil..1 in Name of assignee or other owner or holder of mortgage �tx
Address of assignee(number and street thy,state,and ZIP code) K4t.A/
Does applicant own property in any other If yes,what county? 14 J/_8/80 equested on properly
county in Indiana?
❑ yes ❑ No I ❑ yes ❑ No
COUNTY AUDROR •
Deduction approved in the annum of •
20 20 20 20 20 - 20 20
Signature of County Auditor County Date(month,flay,year)
I 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 I con[1(rt d b r aforementioned property on date application is filed.
Slrtrewr/y6�pjis fiN • "'• Date(month,day,year)
Full resident of- t number and-.--4 may,sta- -. r P code
X00 %r, , �• • G 3 9
son autnorzed by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,tear)
Address of authorized person (number and street city,state,and ZIP code) .