HomeMy WebLinkAboutMortgage_Bracher ra, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coon Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Ovate Form 43709(Ftta t tats) .
-:'-=,-'j Prescribed by Department of Local Government Finance
INSTRUCTIONS: L •aa
To be filed in person or by mall. xrwf.• •
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought.
Must be fled or postmarked with the County Auditor or County Recorder of the county where the pmpedvLs ❑ County Auditor
located on or before 2) Mobile/Manufactured Homes not the
as immediately succeeding calendae year. .JJ UU 1 9 Z O(� �„nty Recorder
Property-.Must file with the County Auditor of the county .
where the property is located dung the twelve(12)months before March 31 of each year the deduc8arj sought
See reverse side for additional instructions and qualifications.
,NpICO n ,
Apo owneraconredbryer- restrictions onreverse ) - GIBBON COUNTY AUDITOR
T /Distx) number!legal description Read number Page number
,o6,-0.5.-- .3/ - ciao , oov. / 95 - orx7 a0/ 7 . 3 OS-7
Assessed value of rarCdes of Mortgage I Contact indebtedness unpaid as of - Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
assessment dale,current year assessment date,=rent year date of application legal or d owner?
1/ 6 p 0 ❑ Yes ❑ No
If no,what is his!her exact share of interest? If owned with someone other thin spouse,indicate with whom •
If name on record is different than that of applicant,indicate below: �sn the p in question:Annually Assessed
}Real Property ❑ Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract setter
Address of mortgagee or contact setter(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage ' R'n( [�� 1[,may' -
of assignee(number and street d i)state,and ZIP code) Y //(Z Accra`I L
I T M SE .3/ -I-/a . 987 , - c ,A )
Does applicant own property in any If yes,what county? - what Taxing District? H ge OW 1) AAL_
iindiana?? ❑Yes ❑No • - a tL /1 ____
A person is not entitled to this deduction unless the person has a balance on the person's I tH, '/v1 00 0 t
recorders office(incfudmg any home equity fine of c edit that is recorded in the county rea 7T Q\ ty
COUNTY AUDITOR `5 ri'Lk..-Ci r-t _
Deduction approved in the amount of �' L -a(- � 1
20 20 20 20 ✓0 5� _
Signature of County Near County 1
!We certify under the penalty of perjday that the above and foregoing ifi(oririaton is ter ao\ �'/\ td
owner!contract buyer of the aforem-A r• -• property on date application is filed.
.,_is(owners J;-, .)4., / _ Data(month,day.year)
ut resident a dress of appliicant number and street city,state,and ZIP code)
19,2—Y P!. OQJ /0dubaPIzt Ad. '116, 70 P at i t t.,)Person authorized by duly executed Power of Money or by 6-1.1-12-0.7 ► Date(month,day,year)
Address of authorized person (number and street cry state,and ZIP code)
The penalties for perjury can indude imprisonment up to two and a half years and a fine not to exceed$10,000. 8 1n
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