HomeMy WebLinkAboutMortgage_Krieg (3) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
tFOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R13!10-15) (`a�J�1 Ctn� 2 \
`- Prescribed by Department of Local Government Finance J
INSTRUCTIONS: File Mark
To be filed in person or by mail. F 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'where the property is County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file with the County Auditor of the county
where the property is located during the fweIw(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
ApplicsuaLlowner or contract buyer-see • on reverse side) r
00-0
Taxing W 11 `l-Tri J 1 1`^' 001 O Record number_r� Page number
• 2 3 S6
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as M indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year B N ti legal or cronies?
S S J 1• Yes 0 No
If no,what is his I her exact share of interest? If waned with someon other than sp)ouse,indicate with whom
If name on record is different than that of app&carq indicate below Is ,,property in question:Annually Assessed
T rr"'-i'u •• is \ Annuaty Assessed
• f { I '1 Moblle Hon (IC 6-1.1-7)
Name of mortgagee or contract seller �./1 \€ c
Address of mortgagee or contract seller(number and street city,sate,and ZIP code) APR 16 2019
Name of assignee or other owner or troller of mortgage /I
57P
Address of assign--'----'—
L 0 / g T 3 54 b GIBBON COUNTY AUDI i uR
Does applicant a. �(, isticl? Has this deduction been requested If yes,state amount of deduction
other county on property for
in Indiana? Drawer NO current year ❑Yes ❑No
A person is note. �n the person's mortgage or contract indebtedness that is recorded in the county
recorder's office i the county recorder's office)that is the basis for the deduction.
Card NO. 4TY AUDITOR •
Deduction approve
20 20 . 20 20 - 20 ' 20' 20
Signs of County Auopor jiiCounty Date(month,day,year)
CAN TIM
I 1 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.
XSignature full name) Date(month,day�ear)
F g a •t(9eylm''1 �`s�ate,,,a'n`dZlPcode) .(� I,%� (.A 116
Person Gs 1�uly executed
V of I oy\ I`^i W by IC 1W� � ' 1 Lei— l9 . Date hnoinday,rei
Address of authorized person (number and sheet 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 310,000.