HomeMy WebLinkAboutMortgage_Yeager (2) .} STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS _ County FILE ")
Year
Co"c.� �, 1LJ
FOR DEDUCTION FROM ASSESSED VALUATION
,..
�..'- State Form 43709(R111 6-09)
Pn�mbed by Department of local Government Finance
He Mark
INSTRUCTIONS: NOV .irlim•. th.
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought • Count Auditor
2) Mobile/Manufactured Homes not assessed as Real Property.Must tile during the twelve(12)mon i r
before March 31 of each year the deduction is sought - �. • 111411,71b,4 County Recorder
See reverse side for additional instructions and qualifications. GIBBON CO . . : -
Ap... ai. t idei/Y).r .C�11
Taxing V ∎••I Key ben/legal description Record rum P e
7 -act- ar— l ., ad A/7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the appdaant the sole
Mania 1:harem year March 1,anent year //// date of aP ���j ��J� legal a equitable owner?
24 vdo ���-" y _ Ci ❑ Yes ❑ 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 different than that of applicant indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Motile Home QC 6-1.1-7)
Name of mortgagee or contract seller
Address oLCi(fiaoeelor contract seller(number and street,city,state,and ZIP //</%
Name of assignee�or other owner or holder of mortgage
Address of assignee(number andsbee4 city,state,and ZIP code) ,1
020 At La( .. -,A:-_. a _1
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? for current yea
❑ No r?
❑ Yes ❑ Yes ❑ No
COUNTY AUire."
Deduction approved in the amount of:
I
20_ 20 `/^7C/J/mJ' 20 • 20
•
�1•I. •....\.•Signature o county Auditor D)"a\�er O•••••• j��/ I Date ntisa day,sear)
I/We certify under the penalty of perjun (.%.....•••• 1 that the applicant is a resident of Indiana and
ownerr4 trail buyer. the-•• -.-anti Card NO' ••.••
1 Sig o 7.4 A Date(month,day,year)
f �, ''i'WW'7'
F ent address of.... .. t(number and L ofy,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 5-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,end ZIP code) .