HomeMy WebLinkAboutMortgage_Fidler f STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
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....• I FOR DEDUCTION FROM ASSESSED VALUATION
State Form 63709(R111 fi-09) F J
Prescribed by Department of Loral Government Finance x FZIE'11TIet(t—i n
INSTRUCTIONS: t�
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. r} '1 Q 14
Fling Dates: 1) Real Properly Must file during the year for which the deduction is sought D County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property.Must Me during the twelve(12)months � �
before March 31 of each year the deduction is sought - I(r6
See reverse side for additional instructions and qualifications.
GIBBON COUNTY AIICrrOR
Applicant( or contract buyer-see restrictions on side)
Tad istrirl i Key number/legal description Record number Page number
Ala-14 - /8 - 0. 0.7 -cos.? -03.8 -i� 3 -7 7S
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact Indebtedness unpaid as of Is the applicant the sole
March 1:anent year March 1,current year data of applCaton legal or equitable owner?
5le, 0.0 a 0 Yes 0 N
If no,what is his I her exact share of interest? If owned with someone other than spouse,Indicate with whom
If name on record's efferent than that of applicant,Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑AnnuaflyAssessed
Montle Home(IC 61.1-7)
Name of mortgagee or contract seller
a,ieneft_ 462/Yri-Address of mortgagee or contract seller(number and s�t,city state,and ZIP code) M C-
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,ct state,and ZIP code)
•
Does appfoant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ No fur anent year? ❑ Yes
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
gy t-. ` ' / County Date(month,day,year)
I/Wear'Ally under rthhee penalty of'f/perjuYµry th~iat-the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
■ icon buyer of}}}yyyggq--aforementioned property on date application is filed.ovi,x Sig icon
Date(month,day,Your)
K " . (n and scree( state, ZIP
(Xx auh� i /tz `rn ���/ 2/�1�/7d 7b
Person authorized by duty exec Power of Attorney or by C 61.1-12M. / Date(month,day,ye
Address of authorized person (number and street,may,state,and ZIP code) .