HomeMy WebLinkAboutMortgage_Strader s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
e:-.?�?� FOR DEDUCTION FROM ASSESSED VALUATION
`„_ '° State Fonn 43709(R13/10-15)
�- Presatbed by Department of Local Govemment Finance ���((( MM
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INSTRUCTIONS:
To be filed in person or by mail.
Ming Dates 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought nn..
Must be filed or postmarked with the County Auditor or County Recorder of the county where the property rjaJ N 0 4 �ounty Auditor
located on or before January 5 of the mmediatety succeeding calendar year” County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the Iwehe(12)months before March 31 of each year the deduction is L.
See reverse side for additional instructions and qualifications.
Applicant(owner or contract restrictions ojn reverse- p��— /� GIBBON COUNTY AUDITOR
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Taxing District lit G , � I - -3 OIC-.C..o i. " 19�lZLo�,Q.L� rsecord�/ 1 !b0
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of r ortgage/Contract indebtedness unpaid as of Is the applicant the sole
assessment date,anrert year assessment date,current year te of application legal or equitable owner?
S t CM� 1:i Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than sums.,indicate with whom
If name on record is drt(ecent than that of applicant indicate below. Is the property in question:Annually Assessed
❑Real Property ❑ AnnualyAssessed
• Mobile Home(IC 0-1.1-7)
Name of mortgagee or contract seller r' n
Address of mortgagee or contact seder(number and t, ,state,a P e) _C
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,city,state,and ZIP code) __
Does applicant own property in any If ye U Z _C, O�6 lion been requested If yes,state amount of deduction
in Indiana? ❑Yes ❑No AV J ID Yes 0 N
A person is not entitled to this dedudio 1.3' \\'1 (;_Tr,r-d Cz'E-ko E LQ A \ contract indebtedness that is recorded in the county
recorder's office(including any home e. 1 ).,..-k\ er A 0 vc act eJ°� )that is the basis for the deduction.
Deduction approved in the amount of: Qv_c \I.,w'°' 1' a_ b
835 `b o0 1
20 20 I <u I 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing informations true and coned and that the applicant is a resident of Indiana and
own /contract buyer of the aforementioned property on date application is filed.
Si r (oh I name) , J} Date(month,day,-i ?
5. r ent address of applicant(nu and street, " ,state,and ZIP code) 1!'�X/' ^= 'l l b ! (/O )_7/ (/
Person authorized by duly executed Power of Attomey or by IC 6-1A-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry,state,and ZIP code)
The penalties for pe¢tay can include imprisonment up to two and a half years and a fine not to exceed 510,000. "--- - -