HomeMy WebLinkAboutMortgage_Rostron STATEMENT OF MORTGAGE OR CONTRACT I EBTEDNESS County Township Year
It'. DEDUCTION FROM ASSESSED VALUATI I L ED
State Form 43709(R11/6-09)
Presm'bed by Department of Loral Government Futamce
File Mark
INSTRUCTIONS: DEC 8 (l d with: .
To be filed in person or by mail with the County Auditor or County Recorder of the county where the prop et/Is located. F�
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must h7e,gU/ng the t�yeN�c./r2}menths County Recorder
before March 31 of each year the deduction is sought )VOIEIIL �
GIBBON COUNTY AUDITOR
See reverse side for additional instructions and qualifications.
Appazantit,in -seeistrit reverse side)bri,lk...2
muMer,legalV p T ma . FOC t 6)- G3I- '-000333 co-trLA/1 J Record number
o Page n/�8
Assessed value of real property as of Mortgage/Contrapl4ndebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
0.1ar1,1;asrent year Marti 1,anent is, date of application legal or equitable owner?
1500 oyes 0 N
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate wi h whom
If name on record is different than that of applicant,Indicate below. -
Name of mortgagee or contract seller r) /� r Drawer ,O ' i
Address of mortgagee or contract seller(number and street,coy,state,and ZIP code) 56-2/7.
Card NO.
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,oat:state,and ZIP code)
Does applicant t own property in any other If yes,what county? • What Taxing Di strict? Has this deduction been requested at property
county in Indiana? for current year7
❑ No
❑ Yes ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(moral,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 I contract buyer of the/,a/f/o]rementioned Property on date application is filed. •
�r�lgmf- (owrrP_ /t ,14/`i!-O"`� Date(rnw+a+,day,yeah
Full l'Yresid} of applicant(number and street,aN state,and LP code)
)r'„Z06 -. * I �Lr/Jsr d/n) 4763_9 •
• Person authorized by duly executed PoweGbf Attorney or by IC 6-1.1-12-0.7 / Date(month,day,year)
Address of authorized person (number and street,dry.state,and LP code) .