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Home My WebLink AboutMortgage_Powers (4) FILED #—!, STATEMENT OF MORTGAGE OR CONTRACT INDEER36A&W 8 County Township Year .4- . FOR DEDUCTION FROM ASSESSED VALUATION (()S /� State Prescribed Form 43709(partme t ) o ilivAN��a��650/5 ' Prescribed by Department of Local Government Finance n INSTRUCTIONS: GIBBON COUNTY AUDITOR 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 county where the property is 'u0' County Auditor located on or before January 5 of the immediately succeeding calendar year. 2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county Canty Recorder where the property is located during the twelve(12)months before March 31 of each year the deduction is sought. See reverse side for additional instructions and qualifications. Applicant(owner or contract buyer-me restrictions on reverse side) %ymoI%j 3 Mided$ description R_ _ ageDDisaid� K Zu�her/1/a3l 43 -/ ^ /'� /O� M � �O/ST Page 9 Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/ContractUindebtedness unpaid as of Is the applicant(he sole assessment dote,anent year assessment date,current yeardate of application legal or equitable owner?owner?30^ ^ 0J � ❑ Yes ❑ No If no,what is his/her exact share of interest? ff owned with someone otter Nan spouse.indicate with whom If name on record is different than that of applicant,indicate below: Is the property in question:Annually Accnssnd I Property oualty Assessed . Name at iron,.._.or contract seller ar, 1raoanczr71--) n2trn �`= Ti ' " " 1 75 kl J — Address of mortgagee a contract setter(number and street.city,state,and ZIP code) Name of assignee or other owner or holder of mortgage \�^`�+, Address of assignee(number and street.city state,and ZIP code) (✓v ' ' 1..1.1� n/�p/�I��1� _. Does applicant own m a If 8t0, ^ /0 �l./�J l l�i.� property any yes,what county? What Taxing District? ..,.....1/J..,,.J(/J_yv_', other county N on property for in Indiana? ❑ UGYes O current year? ❑Yes No A person is not entitled to this deduction unless the person has a balance on the person's mortgage or contract indebtedness that is recorded in the county recorder's office(including any home equity line of credit that is 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 County Auditor County Date(month.day.year) I/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 aforementioned property on date application is filed. Signature(owner's fug r ) Date(month,day,year) % r ^—. Full resident a of ' n (number and street,cty sta and ZIP code) d Person authorized by duty executed Power of At mey or by IC 61.1-12.0.7 Date(month,day.year) Address of authorized person (number and street.aty.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. • '� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year FOR DEDUCTION FROM ASSESSED VALUATION qqqq®® State Form 43709(R13/10-15) E Prescribed by Department of Local Government Finance JJLyyL..��r/r AAA/ INSTRUCTIONS: .. Ile Mark To be Wed in person or by matt OCT 1 201 Form fited 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 county where pe is County Auditor located on or before January 5 of the immediately succeeding calendar year: a County Recorder 2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Au - 11101 UDII ahem the property is boated during the twelve(12)months before March 31 of each y®}B (4 Z so See reverse side for additional instructions and qualifications. App6rant(owner or contract buyer restrictions on reverse side) ram, a /4�, Taxing District Key number/legal description Record nunwr Pmnumhstrn C a & - / 3 - ,2 .3 - iol-- e0o• /08 - oo L. ,-20 Y Assessed value of real property as Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole assessment dare,amend year assessment date,current year date of apyboation legal or equitatie owner? . 00f GO ❑ Yes 0 No If no.what is his/her exact share of interest? If owned with someone other than strings,indicate with wham If name on record is ddferent than that of applicant,indicate bebrr Is the property in Question:Annually Assessed 0 Real Property 0 Annually Assessed • /) /,/f Mobile Home(IC 6-1.1-7) Name of mortgagee or tract seller j /r�1F-'V 6_-v ('Q�J_ g Address of mortgagee or contract seller(number and sheet a t state,and ZIP code) Name of assignee or other owner or holder of mortgage — Address of as ` /O �� Drawer NO..1/f_7l/ Does county on - - g District? propertyi deduction been requested If yes,stator amount of deduction • other in Indiana? - j('��^•`�'� anent year? ❑Yes ❑No A person is n Card NO. ••••S"`-' l x on the persons mortgage or contract indebtedness that is recorded in the county recorder's of din the county recorder's office)that is the basis for the deduction- • OUNTY AUDITOR Deduction approved in the amount of 20 20 20 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 information is true and coned and that the applicant is a resident of Indiana and owner I contract buyer of the aforementioned property on date application is filed. l i 5' ( hra a ;6/ 7 Date(month,day fear) xll,, address of r mbar and street cityy,,,stale,and ZIP ogle) /O////S— '-r Pe •rson authorizIed by AA;uty Power of meJ by-IC 2-0 7 - a r Cf r F "7ate 6- YeaO i 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$10,000.