HomeMy WebLinkAboutMortgage_Pinnell , . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County Township Year
1 FOR DEDUCTION FROM ASSESSED VALUA L
State r"roan 43709(RI 1 16-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: APR 2 2015
Form coed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought g County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must fil urin th months
before March 31 of each year the deduction is sought ` jQr1{ County Recorder
See reverse side .itional instructions and au-lifications. GIBBON COUNTY AUDITOR
Applicant(owner lxiic.e
Key / description Record Page
IN 'Iii sir ' 14-19-/Oa-000. 8337 IS Ea?
value citeal .. of AWrtgage/, tract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the epp l ant the sole
Math 1,anent year Meenmhh 1�"Mnsa�arO date of appfiratun legal a equitable awned
El Yes ❑ No
If ex
no,what is his her exact sham 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 p Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller �� /^
Ac— — I ZIP code)
Na //A/r fr
Adc
/go..7... •
Card Doe C CI 0• ••.••••••
• • What Taxing District? Has this deduction been requested an property
COW for current year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20_ 20 20 20 20
Signature e,, Audtor /' / Court 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. .
'.nabrm awne's M I me) tom,-----e,e-e Date(mordh,day,year)
.f 11 resident W applicant(number and sheet obi,state,and ZIP code)
n+` - 1�. 0 , Tr'us4er sr Op3i(cp,vO (ry z 4 Y7o0a
Person authorrzed 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 sheet city,state,end ZIP code) .