HomeMy WebLinkAboutMortgage_Powellj-i�o STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS nt o ns ip r
.A�! FOR DEDUCTION FROM ASSESSED VALUATION
S' State Form 43709 (R71 / 6-09) .
�� ;�,. � f` Prescribed by Department of Local Govemment Finance
i e Mark
INSTRUCTfONS:
To be �led in person or 6y mail. ,F1e°"^„ f
Filing Dates: 7) Real Property: Must 6e completed and dated in tha calendar year (or which the deducfion is sought.
Must be filed with fhe County Auditor or County Recorder o7 (he counry where the property is loc � y�(3{T$�1��or
on or before January 5 0( fhe immediately succeeding calendar year. ��S�N � Couny Recorder
2) Mobile /Manulacfured Homes�no! assessed as Real Property: Must file wi(h the Caunty Auditor o7the
counry where the property is located dunng the Rvelve (12) months before March 31 0/ each year the
deducfion i5 sought.
See reverse side for additional insfructions and qualifications.
Apd�ni (owner ar contrdcf buye�- sce 2svicfions q� reverse side) n
'�l
wsessed van�e a reai vropenr as w
MafCh 1.artenlyear
If no, what is his / her euct s�a2 of interesi7
e/
'name on recortl rs tlifterent Nan Nat ol apd�nl. in0icate Oebw:
Name ol mortgagee or conVa ell r
��lle SZ_
Addreu of mort9a9ee or mnVact seller (number antl stree(, ciry, state,
Record number
�/� � 0
as
It owneE with someone o;her Nan spouse, intl&ate vriN whom
� applirant ihe sde
w eVUitade owneY?
❑ Yes ❑ No
�Is-c,/t�e propertyinquestbn:MnualtyASSessed
�p Real Property ❑ MnualyAssessed
/ � MobBe Home UC 67
Name of assgnee or other owner or taMer ot mongage __. ._—
-; "'___�—.i'—
Addressotassignee(numbe�ands(reet,city,stare,andZ/P< Dra���er NO....:?��u
Oces applirant ovm property in any oNer I( yes is lhis deducLOn been requestetl on pmperty
counry in InOiana? I �• ' curtent yeaR
❑ Yes ❑ No Card N�. .... �.l � ❑ Yes ❑ No
Detluction approveE in t9E amount oL �
zo _ zo zo
Signature of Counry Auditw
c�6-/9-i9-/o-j-ao% a/� -o�r6
20 � 20 _ � 20 _
Date (rtronN, day, year)
rz��
I I We certify under the penalry oi perjury that the above and toregoing infortnation is true and cortect and Nat the applicant is a resideni of Indiana and
owner / convact buyer of the aforemeniioned property on date application is filed.
�natu (awne/s tu0name) Date (monfh, day, year)
' Lt��.c�l-k�.P. (Pawe.eP 3- ro-2o I o
a0dress bl appircan� (number and street, ary, sfate, aiM ZIP code)
? I S. f�rtoiee Ln. Fo�f gra.,�/, !N 47648
�rizetl �y tluty executed Power of Attomey or Oy IC 6�1.1-12-0J
AdOress of authonzeE persan (numberarM sneef, cify, stafe, arM ZlPCOtle)
day, yea�