HomeMy WebLinkAboutMortgage_Otto STATEMENT OF MORTGAGE OR CONTRACT I ' : D, ES S ounty Township Year
ck;;: FOR DEDUCTION FROM ASSESSED VALUATI•I. ! !
L-.i.; State State Fonn 43709(R11/6-09)
Prescribed by Department of Local Government Finance File Mark
INSTRUCTIONS: DEC 2 2 2014 Form filed with:
To be fled in person or by mad with the County Auditor or County Recorder of the county where the property is located.
Fifmg Dates: 1) Real Property.Must file during the year for which the deduction is sough�t.���h County Auditor
2)Mobile/Manufactured Homes not at'sessed as Real Property Must Re cVdl7/tK- months
before March 31 of each year the deduction is sought 4 County Recorder
See reverse side for al instructions and qualifications. GIBBON COUNTY AUDITOR
Applicant(owns c
-see on r /
K /legal description
Record number Page n
6—as-/a-S -ooa- Yas-&(f ,,20/3 a9
• ,/oo value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract Indebtedness unpaid as of is the app8rant the sole
- 1:asrert yrar March ,crnreat year '/ data of apprxatlon legal a equitabie owner?
0`7"0/Do-0 ❑ Yes ❑ No
If no,what is his I her exact share of interest? f 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 hi Question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /7 n /J
Address of mortgagee or contract seller(number and street,city,`�Lstate,wannd ZIP code)
Name of assignee or other owner or holder of mortgage Drawer iN U�/..rte_./� -- —
Address of assignee(number and street,city,state,and ZIP code)
Card \7 O O% G ,
Does applicant own property in any other If yes,what c on been requested on property
county in Indiana?
❑ yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount ah. .
20 20 20 20 20%ny//-)^1�/(]/jj� 20 20
Signaling Cot {r County Data(month,day,year)
I certify under the penalty of perjury rjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and 47jel (
e d
owner I contract buyer of the aforementioned property on date application is filed.
nature/1 eras IWI ) Fick-- Date(n»Nh,day,year)
y ( / P'P',','�j'/ l//�/7IJJ�bC,//. t/p/ r L / 1 (� Q
ull resident 74 d�to. (naOkicIT /t�'tQ' �l 'l; ; h/&al3a4acU /k) 't 7 3 l
\34)1\ Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 t Data(month,day,year)
Address of authorized person (number and steel,city,state,and ZIP code)