HomeMy WebLinkAboutMortgage_Rowe (4) s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e._;
-v.;: FOR DEDUCTION FROM ASSESSED VALUATION y.
State Form 43709(R11/e-09) a ��
Prescribed by Department of t. Government Finance t i
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File Mark-
INSTRUCTIONS: �f11CC �y�,
To be filed m person or by mail with the CountyAuditor or County Recorder of the county where the property is Iocat9f4.C 2 f /41 jf
Ring Dates: I) Real Property.Must file during the year for which the deduction is sought lriJ County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property.Must Re during the twelve(12)mon
before March 31 of each year the deduction is sought Recorder
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Applicant(owner contract buyer-see reshirtwas on side)
Ta-at-6-o-t�G,-Ili 3i - 303 -o0o . ova -009 Record 0>- P�39 //
Assessed value of real property as of Mortgage/Contrail indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the apptaarl the sole
Mach 1,anent year =yew/
anent year date of ap n legal or equitable owneY?
9000 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indite wtth whom
If name on record is(afferent than that of applicant Indicate below I Is the property in question:Annually Assessed
Name of mortgagee or contract seller si 3 �0
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code)
Drawer NO
Name of assignee or other owner or holder of mortgage 3 1`f^
Address of assignee(number and street city,state,and ZIP cgtlq) Card NO.
C
7(/ 31s/3f
Does applicant own property in a other If yes,what county? • What Taring District? was this deduction been requested on property
county in Indiana? El yes ❑ No I for current year? ❑ Yes ❑ No
I
COUNTY AUDITOR
Deduction approved in the amount of. •
20 20 20 20 20 20 20
Signyre of County - County Date(month,day,year)
I/We ice.certify,u/r-A derrtthhe 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 aforementioned property on date application is filed. .
I' 'a -t,i� ) (/c Date(month,day,year)
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rf rest.ent address applicant(number and�st�e�el,1oLry,state,and ZIP code)
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Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day,year)
1
Address of authorize)person (number and street,city,slate,end ZIP code)