HomeMy WebLinkAboutMortgage_Martin (34) t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
-- .- State Form 43709(R11/6-09) ��
Prescribed d ern
ed by Department of Lo Government Finance
INSTRUCTIONS: .
lb be filed in person or 6 mail with the Court Auditor or County Recorder of the court where the property F ial 2�
Y County ic county p PertY is located. DEC 1 rot
Filing Dates: i) Real Property:Must file during the year for which the deduction is sought L J Z l+:.nty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought - El County Recorder
See reverse side for additional instructions and qualifications. GIBBON COUryR
A p p li c a n t or c o n t r a c t buyer-see restrictions on reverse side) -
Taxing District Key number/legal description Record number Page
4 ?-01 - cloy- o oo. 0!S- o A- ao i Y ti v
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Mash 1:current year March 1,current year date of application legal or equitable owner?
/101600 ❑ 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 is different than that of applicant induate below. Is the properly in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and sheet,city,stab,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number andd street,city,slate,and ZI%••.e
/ _� e. -
Does applicant own property in any other If yes,what county? - What Tan ^_^^.'//
county in Indiana? ' 1 O/q'•
0 Yes ❑ No Drawer Np, `/( —
...........
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COUNTY AUDITOR 7� // �•
Deduction approved in the amount of - Card ]\1 C/. C�//
20 20 20 20 - , _
I I
Signature o ty Auditor • . • County Date(north,day,year)
I/We We ce nal 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 aforementioned property on date application is filed. .
Signal (owrrers tuft name) Date(month,day,year)
e "(A
ul resident address of applicant(number and street,crl):state,and ZIP code)
ti°y r441r( 3C' Starr W o..ensvIle rev 4766f
Person authorized by duly executed Power of Attorney or by IC 6-I.1-1M-0.7 Date(month,day,year)
Address of authorized person (number and steel,city state,and ZIP code)