HomeMy WebLinkAboutMortgage_Hayes (2) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Ara FOR DEDUCTION FROM ASSESSED VALUATION
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State Farm d by 43709
Department nt 6-09)
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Prescribed by Departmed d Local Government Finance
File Mark
INSTRUCTIONS: p� a 2015
To be filed in person or by mail with the County Auditor or County Recorder of the county where the is test Form reed�� •
Fiimg Dates: 1) Real Property.Must rile during the year for which the deduction is sought M County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the toe (12)rn
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications. GIBBON COUNTY AUDITOR
Applicant(owner or,,contract bbuyer-see resti/di ns on verse side)
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T 7g istrirt Key number/leyal don Record number Page number p�
2/n -2 D(o— r�/)O 006 �>/ h -Oo q Z6/y ZISl (7
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
March 1,anew year March 1,arrtent year date of application legal or equitable owner?
/00 000 ❑ Yes ❑ No
tr 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,indicate below. Is the property in question:Annually Assessed
• Weal Property El Annually Assessed
Mobile Rome(IC 6-1.1-7) .
Name=era or tract seller
n a., - S://
Address of mortgagee or contrail seller(number and street .state.are ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) /1(o --— _
Does applicant own property in any other If yes,what county? • What 4u`3 CIS :y
county in Indiana? /t ./
Yes ID No Tot � No
COUNTY AUDIT( /t `lL�t
n
Deduction approved in the annum at - (lw Jt- dD C)
20 20 20 20
Signature of Canty Auditor • County Date(month,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 aforementioned property on date application is filed. .
Sigma (ownefs NO name) Date(month,day,year)
xCi�mc( C
Y
Fun�b 05 �S 9-f(� , lAvic t l -cu_kbs- ed f-, —Eiv 4'743S
Person authorized by duty executed Power of Anorney 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) .