HomeMy WebLinkAboutMortgage_Atchison""� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun s p
,,_ • FOR DEDUCTION FROM ASSESSED VALUATION �
� State Farm 43709 (R11 / 6-09)
�,,,, ` PresaiGetl by DepartmeM of Laxl GovemrneM Frence
wsrRUCnoNS: �d
F''�"`5 2011
To be hled in person or by maii wiN the CountyAUditor or Counry Reco`der o/ the county where the property is located. F� `.�'
Filing Dates: 7J Real Pmperty Must �de dudng the year (or which tha deducUon is mughG � Coun dit
2) MobAe /Manufactuied Homes irot assessed as Real Property Must file dunng the twelve (12) monNs
6efae March 37 of each year the deduction is sougAt G BS� C��R �
DITO
See reverse sitle for additional instrucUons and qualifications.
IAppfimnt (owner trad b - see m.sfir�rns m rererse siYe)
��o_,��.��:���_. ����,, L
Cer / le�jal desaiption
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fIG'�R'%*
Y�
what 5 n¢ l lrer e� sliare
It name on remrE is tlirterent Ihan thai ot applNant, rt�dv2ta below.
Name ot
u mnuatl seUer
mntrad se0er (mmEer antl stree4 �1: sfate,
AOC2ss ot assignee (rwmber aM sveeC rdy. slate. and LP ootle)
� Recrnd number Page numbrl
- — a.o � � sa 3g
Iness unpaid as N Mongape / ContraG "uNe6teCness unpaid az d Is Ae eppGonl the mle
Eate of appGtltim kgal n eQUitaHe owrre(1
� es ❑ No
If avmed with someane dher ihan spouse, ind'xate with xinn
s�perty in Guestion: Mm�eEy Assessed ''
�v�N ❑!�!+!�?aM�
Oces epplimnt own p�operty in any oNU If yes, what munt�? Wha� Taring Distrid?
munty in Ind'ena? r�
❑ Yes pFJ'No
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—. .o lJ No
COUNTYAUDROR
Orducrion approveE in tlre amount oF.
20 _ 20 _ 20 20 _ 20 20 20 _
$igraMa M ComN Auditw Counry Dale (month, daY. Y�A
1/ We cerlify under the penalry of perjury that the ahove and foregoing in(ortnation is W e antl cortec[ and Mat the applinnt is a resident of IrWiara arM
owner I contract buyer of the afo2mentioned property on date application is filed.
Sip o fidreme) Date(month.daY.We�
F residen ol appGmnt (number antl sbae4 bty, state, and ZIP mda)
�Q 89i S Yso w p,�NS�s�cE 2 7G .S'
P�oo awn�a�e nr amr e=ew�ea ao.er aa�«�er or cy �c si.�-i z-0.� ?� o� poo�,u, aar. ree�
PddressofaWmrtredpuson (numberarndstree;ay,sbte,andLPCOde) .
- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township�:,.
; FOR DEDUCTION FROM ASSESSED VALUATION
. ; h: State Form 43709(RU/6-09)
Prescribed by Department of Local Government Finance fitRITL
File Mark
TRUCTIONS' F'AN4._Q_`1013
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. t�utf l"'!J'.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. • County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)months
before March 31 of each year the deduction is sought. %rMI�S —^'ar
See reverse side for additional instructions and qualifications. ',/q��/ GIBBON GuU Pie AUDITOR
Ap owneror dbuyer- _/ an'eve side) /9 / ,fg ""
lr"
Tap, D' ct • r n / desai Rea number Page number
/t_7Q n_ *4- ooa. &.c-oar a O M .5-993
A value of real property as of Mortgage/Contract Indeebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app�nt the sole
March 1,amens year Harris 1 anent year date of appll legal ar equitable amen?
Or � 0 Yes 0 No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
•
If name on record is different than that of applicant,Indicate below. s property in question:Annually Assessed
eal Property ❑Armualy Assessed
/'y �n Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller `j/��tr1 , �co / ,irit.f .t
Address of mortgagee or contract seller(number and state,and ZIP code)
Name of assignee or other owner or header of mortgage
•
Address of assignee(number and Street.dry,date,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for anent year?
❑ Yes ❑ No ❑ Yes ❑ No
®
COUNTY AUDITOR
Deduction a —-
roso. 60 _D
20_ - ,1 � 20 20 20
Draper NO �,{//l/l1 Date(month,day,year)
Signature r ...
�/�......... my
I I We Card NO S -/9 g information is true and correct and that the applicant is a resident of Indiana and
owner,- • ''••••.....,... ation is filed.
S gnattS(owner's fu a^� Date(month,day,year)
1` t4Z'1- r r 2r. .)v-ii'T7 I
Full resident address of applicant(number and street,oily,state,and ZIP code)
-'c 77 Gr) 6(/LJ S 6101 f 374/t Lc./ 4/7‘e,Ls.S
Person authorized by duly executed Power of Attorney or by IC 6.1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)