HomeMy WebLinkAboutMortgage_Koch (2) •-; STATEMENT OF MORTGAGE OR CONTRA IND ED County Township Year
tFOR DEDUCTION FROM ASSESSED VAL ATIIN
--tk state Form 43709(R11/6-139)
Presaibed by Department of Local Government Finance
INSTRUCTIONS: OCT 7 2014 File Mark
Form Ned with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the pe as located.
Ring Dates: 1) Real Property:Must file during the year for which the deduction is hL. I��-(y, County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Millie,. We(12 nths y-r
before March 31 of each year the deduction is sought //�"`'' T �o LJ
See reverse side for add'(/'�rtyl�instructions and qualifications. 11 GIBBON COUNTY AUDI K County Recorder
ADM�rrt(owner or restrictions on 5Q1sidel/O p¢rI
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Assessed value of real property Mortgage/Contract indebtedness unpaid as of Mortgage I Cat-act indebtedness unpaid as of Is al applicant the sole
March 1,anent year Matc448771�pr?o 00 data of application ��Q Yes ❑ oN
If no,what is his 1 her exact share of interest? �///(`I/_UY If owned with someone other than-prima,indicate with whom
If name on record is ddfernt than that of appliant.Indicate below Is the property in question:Annually Assessed
• ❑Real Property ❑Annually Assessed
Motile Home(IC 61.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state, P code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,any,state,and L
KOcf D'1122at<-
Does applicant own property in any other If 1 I as this deduction been requested on property
county m Indiana? ❑ No l '-�/`r' r current year? ❑ Yes ❑ No
❑ Yes
Deduction approved in the annum at
20 20 20 20 20 20 20
•
Signature of !water 1, �'n County Date(month,day,year)
I e 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
/contract buyer of the afo - entioned property on date application is filed.
Sig re( wnefs Date(month,day,year)
Silt t address 2f applicant(number and street ary,state,and ZIP code)z
'e`LS35 address 300 3, fJ il/ ., i 7G7°
Person authorized by duly executed 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) .