HomeMy WebLinkAboutMortgage_Mayer (8) rSTATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
; FOR DEDUCTION FROM ASSESSED VALUATION
LIV State Form 43709(813110-15)
-l-- -• Presalbed by Department of Local Government Finance
u,
INSTRUCTIONS:
per 1 ,
To be filed in F,I !.,mtt";
person or by mail.
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is t
Must be filed or postmarked with the County Auditor or County Recorder of the county where the properly is • County Auditor
located on or before January 5 of the immediately succeeding calendar year tt�p q� ..��7'I County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of tfre&G ut- 2 i I I"
when:the property is boated during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications. '/fir^'
Applicant(buyer-sQ nsverse side , l
Vtll °�`'/7 �qy�� GIBBON COUNTY AUDITOR
Taring District 15vy;number i -o 9- 300 - oo_ -oal� Record number Pag`number�
Assessed value of real property as of `�O Mortgage!Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid asl)of I Is the applicant the thhefsole•
assessment date,current year assessment date,current year date of application legal or equitable owner?
(r 26 560 ❑ Yes ❑ No
tf no,what is his l 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 ❑ Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /t �1[J, c. i
Address of mortgagee or contract seller(number and street,city,state,and ZIP �Ccodj�e_)
Add
ache " r Has this been requested If yes,state amount of deduction
in I � �� current year? ❑Yes ❑No
Ape s mortgage or contract indebtedness that is recorded in the county
rei ��l_ —(�—�7 -••rder's office)that is the basis for the deduction.
v R
D=.
_�� i
! ■I, / 20 20 20
6gnc ( _ -- Date(month,day,year) -
I f 2. 4 true and correct and that the applicant is a resident of Indiana and
rn ���...XCC
Srg Date(month,day,year)
( ' v I l ')f sCn - .
Fli 76 C� Date(month,day,yew)
Add/III; ,.,6 �,
The penalties for perjury can include imprisonment up to two and a half years and a fine not to exceed$10,000. .