HomeMy WebLinkAboutMortgage_Splittorff a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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Esc: FOR DEDUCTION FROM ASSESSED VALUATION �1�
• ' � State Form 43709 Department/6-09) I r /
Prescobed by Department of Local Government Finance
INSTRUCTIONS: �pp�7epv
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. rrlrirt G r� ZQ J5
Fling Dates: 1) Real Property Must rile during the year for which the deduction is sought. 0 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must tile during the twelve(12)months
before March 31 of each year the deduction is sought - -�/ un ¢fir
See reverse side for additional instructions and qualifications. GIBBON CO(m-iv AUDITOR
Apprira (ownerw contract buyer-see resm'tibnson reverse side)
Ta'rig OisbiU number/legal — O — C Record O Page�
u�oco a6 X0.3 — oo0 • 40 7 - oos- 2
Assessed vahre of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mach 1,.anent year March 1,current year date of application legal or equitable owner?
I I 'lI 00 Q ❑ Yes ❑ No
If no,what's his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is dferent than that of applicant,trdicate 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 //� _
Address of mortgagee or contract seller(number and street,ray,state d ZIP code)
Name of assignee or other owner or holder of mortgage //�) - -
Address of ghee(number sfreef,dry.slate,and— /code) `l
/fut• �C /0 Drawer l\rp.. (
Does applicant own property in any other If yes,what county? - What Taring District
county in Indiana? ....... : - /
❑ Yes ❑ No Card NO. ^ ��a
COUNTY AUDITOR
Deduction approved in the amount of: •
20ae 20 20 20 20 20 20
Sig n of Cow.tyMrdeor • County Date(month,day,year) -.
�/Ji/L-Qii/t*-�
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 l contract buyer of the aforementioned property on date application is bled. .
Sl o Date( day, r)
let-' 3/a s/2
c/C
ei resident
- of a••.— rand street ary e,and ZIP code)
/0 1 .0741,..1 1r-- r'srg /N y7. v7
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 sbee4 dry,stag,and ZIP code)
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