HomeMy WebLinkAboutMortgage_Lloyd (2) ^•n STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
.,, .-o Coun Township Year
- 'stie jict FOR DEDUCTION FROM ASSESSED VALUATION
•
-fi,-= " State Form 43709(R12/6-14) '
•' Prescribed by Department of Local Government Finance
INSTRUCTIONS: _
1
,'. File Mark
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be filed or postmarked with the County Auditor or County Recorder of the count eit2 toe go}fyrty is Nipounty Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the un
where the property is located during the twelve(12)months before March 31 of each y the-de sought.
See reverse ':- for additional instructions and q alifications.
Applin,-t(o ti er. • Era" er-see restdctionspiavers s' e) (, GIBBON COUN Cr' AUDITOR i -
Toxin isN•t Key numbe /legal dgsdri ' Record number • Page number
co--18- 6 -dor)-00a,3 VS-0aq aoiG, 006
Assessed :lue of real property as of Mortgage/Contra indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,•rrent year March 1,current y date of application legal or equitable owner?
. a-q a 0 O ❑ 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 ,I,l(�'fl�11
Address of mortgagee or contract seller(number and street,city,state,and ZIP code
N
A //
2 -- //a/
C !!TT /6 - - That Taxing District? Has this deduction been requested If yes,state amount of deduction
0 on property for
it current year? ❑Yes ❑No
A 02,73,QD U a balance on the person's mortgage or contract indebtedness that is recorded in the county
re ;recorded in the county recorder's office)that is the basis for the deduction.'
COUNTY AUDITOR .
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of unty udi r n / G County Date(month,day,year)
, -.:1 Lift/ ,thdebiLati L.—, ,
I/We rtify under the penalty of perjury that the above and foregoin information is true and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
Si ture(owner's full name)
�/�`�, ,fl/ Date(month,day,year)
II reside a cant numbdrand stre,pt,city,state,and ZIP code)
4 704 6 i e e-t Earl JI r-I4 27'3 9 .
Person authorized by duly executed Power of Attorney or by ru 6-1.1-12-0.7 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 510,000.