HomeMy WebLinkAboutMortgage_Meredith STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS tcounty Township Year
Sit
FOR DEDUCTION FROM ASSESSED VALUA -1-1!.- State Form 43709(R11/6-09) ILE
Presmbed by Department of Local Government Finance 1 File Mark
INSTRUCTIONS: NOV_l '2,204
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. PeCn�-,� ��
Filing Dates: 1) Real Property:Must file during the year for which the deduction is so t / r /— County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property.Must urin �t+r- w,) 7T2,months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Ap -v (owner or•• buyer-sae restricSiars an reverse side) nn c .
Tali�� Key - ..);legal description Record number Page number
G( Q2�J 7 4, _o5 :57-og3 al 3 loo 0/7 /1/ /4 77
Assessed value of real property as of Alortpage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Ls the spplicf the sole
March 1:anent year Mart]t ,Fv�ntyear date o(aPP� legal orequitable owne/7
�) �/3 ❑ Yes 0 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 afferent than that of applicant,Indicate below: Is property in question:Annually Assessed
Property ❑MnualyAssessed
- 777 / Mobile Horne(IC 6-1.1-7)r
Name of mortgagee or contract seller i
/W/nc:.be and SC I'IIICLIAI Address of mortgagee or contract seller(number end street city,state,and ZIP code) �� ���� �� J"
Name of.assignee or other owner or holder of mortgage / ',JIe�7`'�ti D
Address of assignee(number and street,city,slate,and ZIP cede) 1
Does applicant own property in any other It yes,what county? . \��� ested on property
Indiana?
county in Indiana? J
-
El yes ❑ No 1 ` rJ Yes ❑ No
COI
Deduction approved in the amount of
20 20 20 20 • 20 20 20
Signature of County Auditor County Date(month,day,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/contract buyer of the aforementioned property on date application is filed.
Signature(o rY rue name) �7 Date(mond;day,Year)
Signature
aappliantI(number and sheet.city state,and ZIP code)
5- ag11 E Sis/ e Rd SG Naze/lon . TiJ Li 749(40
Person authorized by duly executed Power of Mornay or by IC 6-1.1-12-0.7 Data(month,day,year)
Address of authored person (number and sheet city,state,and ZIP code) .