HomeMy WebLinkAboutMortgage_Abbott (2) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
-:.:' State Form 43709(R11/6-09) '
Prescribed by Department of Lad Government Finance
File Mark
INSTRUCTIONS:
DEC 1 k: ► ..
ir
Tb be filed in person or by mail with the CountyAuditor or County Recorder of the county where the property is located.
Firing Dates: 1) Real Property:Must fife during the year for which the deduction is sought. ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)month
before March 31 of each year the deduction is sought - �� �,I •unty Recorder
GIBBON CO
See reverse side for additional instructions and qualifications. AUDITOR
Ap Y�xrwi sew or comma buyer-see restrictions on reverse side)
Taxing District Key number/legal description Record number t' Page number
g 2(0 - i8-o ? -t03 - oov. o3Y - o� )— /y Sz86'
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the apprront the sole
March 1;wren year March 1,anent year date of application
/.�/ legal or equitable owner
If no,what Is his I her exact share of interest? If owned with someoreotler man spouse,indicate With whom ❑ Yes ❑ No
It name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller _
TC w
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city%tarn. /Zlp f)T
Does apprirant awn property in any other - If yes,what county? • What Taring District? Has this deduction been requested on property
county in Indiana? for wren year?
❑ No
❑ Yes ❑ Yes ❑ No
COUNTY AUDITC (`CWT l o^
Deduction approved in the amount at - n-V p 1'ZRoeo
20 20 20 20 r icy' L o Fort) o.a(,u Z.. -
Signs of County Auditor. Ie47 . County I"l SaVb
I/We certify under the penalty of perjury and foregoing information is and
owner I contract buyer of the aforementioned property on date application is filed. .
Sig (o (s ffu9m� Date(month,day.year)
Full adie tsof street oTy,state,and ZIP code)
A 1/Dc)L MJCZ -C/z.t eitalrw-w Lee c 4 lie 6,.5
Person authorized by duly executed Power 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) .