HomeMy WebLinkAboutMortgage_McDaniel (3) ti . STATEMENT OF MORTGAGE OR CONTRACT INDE Township Year
FOR DEDUCTION FROM ASSESSED VALUATION rr�r1®rq{ ��
''` State Form 43709(R11/6-09)
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PrrsrnlRd by Department of Lod Government Finance
INSTRUCTIONS: FEB 10 2015 File Mark
Form tiled with:
To be fled in person or by mad with the County Auditor or County Recorder of the county where the property is Iota d.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought 0 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during�hs
before March 31 of each year the deduction is sought
GIBBON COUNTY AUDITOR County Recorder
See reverse side for additional instructions and qualifications.
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Wstrict Key number l legal desaiptmn Record number Page number
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Assessed value of real property as of Mortgagge l Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app�nt the sole
March 1:and year Mar[th 1,current year data of aPPGCation legal ar equitable ownerl
/DO C00 ❑ Yes ❑ No
If no,what is his/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
Real Property ❑AnnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of nnrtgagee or
10 aac Jar --- —
Address of mortgagee or contract staffer(number and street city,state,and ZIP code) (J(3 1 0.k. _
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Name of assignee or other owner or holder of mortgage tool QO a 0 U —
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Address of assignee(number and street city,state,and ZIP code) (. .k,\ . \........l...``
Re�r;«.s_ (ti< - 01y — S >(� —
Does applicant own property in any other If yes,what county? • What Tau Card \r O. ........ ...... J' -1
county in Indiana? ❑ Yes ...
❑ No No
COUNTY AUDITOR .
Deduction approved in the amount of. •
20 20 20 20 20 20 20_
•
Signature of County 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 contact buyer of the aforementioned property on date application is filed. .
Sig an/if rr Date(ma✓h,day,year)
taddress of`VO4a f applicant(number and street city,state,and ZIP code)
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Person auto•- by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number end street city state,and ZIP code) .