HomeMy WebLinkAboutMortgage_Diel sr*** STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
.- `�v„' a FOR DEDUCTION FROM ASSESSED VALUATION
='_f State Form 43709(R12/6-14) -
;eer, Prescribed by Department of Local Government Finance
INSTRUCTIONS: tl7a cli
To be tiled in person or by mail.
Filing Dates:.1) Real Properly:Must be completed and dated in the calendar year for which the deduction is sought. I�I
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properlyris,- 1 Zy„F Counts/Auditor
located on or before January 5 of the immediately succeeding calendar year. UU 11,,Ali County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
ere the property is located during the twelve(12)months before March 31 of each year the deduction is}ught ,
See reverse side I. additional instructions and qua',cations. I 'r
Applicant(owner. .•red buyer-see restrictions on -v- side) / GIBBON COUNTY AUDITOR
Taxin istrid / Key number/le al description / Record bet Page number
2(9-1V- 6-a so - 001 . Iw-oa i l sotto
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,Curren{ ar� date of application legal or equitable owner?
O��J, ❑ 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 ❑ Annually Assessed
Mobile Home(IC 6-1.1-7) -
Name of mortgagee or contract seller ^ stoat_
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) •
Name of assignee or other owner or holder of moth^=nn- 5 -
Address of assignee(number and street,city,sta C:1° /�— So 90
Does applicant own property in any If yes,wh een requested If yes,state amount of deduction
other county ❑Yes El D1-17}Te)' NO Yes
in Indiana? ❑No
A person is not entitled to this deduction un . tact indebtedness that is recorded in the county
recorder's office(including any home equip Card NO it is the basis for the deduction.
UtJUN r r man nil. .
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
11 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/contract buyer of the afo =•--.boned property on date application is filed.
"pp Signar a(i� -r's hill name) / Date(month,day,year)jor
u0 re '•-n dressof ,'.p,.-�t n-7•= an•st-"t•q}Y Sfate�n�ZIP n �7(
4 510 Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 _\e,+�,'•1 Date(month,day,year) •
Address of authorized person (number and street,city,state,and ZIP code)
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed S10,000.