HomeMy WebLinkAboutMortgage_Russell (2)e`° R�" � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township vear
'�--. � FOR DEDUCTION FROM ASSESSED VALUATiON
� Slate Form 43709 (R4 / 1D01) � �^ e^
�� PrescribtW by DeDartmenl of Local Govemment Finance i ��� � .� . ; �
'• �1 1l � � JL.�r
INSTRUCTIONS: File Mark
To be filed in person or by mail with the County Auditor o( the county where the property is located. � E G����� L� 2��3 .
Filing Dafes: 1) Real Property: During the 12 months belore May 77 oI the year the deduction is to 6e,effective.
2) Mobile Homes assessed under IC 6-1.1-7: 8ehveen January 15 and March 31 0/ fiie�year t��c;io� is to be effective.
See reverse side lor additional instructions and quafifrcations. � . y� �� �� �'t /
G.BSO� I COU:IT'� ,�UDITOR I
Applicant (owner or cont2cf buyer - see restrictions on reverse side)
' e e.e v�
Taxing Distrid Key number / legal description
' �Jh`,�"e �'�Ve r ' D I D� DD 7�2 ' �li
Assessed value of real property as of Mortgage / Contract indebtedness unpaid as
March 1, currenl year Ma ch 1, current year
If no, what is his / her exact share of interest?
Record number
� O� �
Page number
Is lhe applicant the sole legal or
ownef? ❑ Yes ❑ No
'� �S z, DDD, o� I
�— If owned with someone other than spouse, indicate with whom.
If name on record is different lhan that of applicant, indicate beiow:
'ame of mortgagee or contrad seller
�'��-�para (3ah1� NaA,
Address of mo gee or con ract selier (number and street, city, stafe, ZIP
�Zi �� 3� A�y� � s �, r r� , inr y
Name of assignee or other owner r holder of moRgage n
�
�
of assignee
st2et, city, state, ZIP code)
Does applicant own property in any other If yes, what county?
county in Indiana?
approved in the amount of:
20 ��{ I 20
��ao �-
Signature
7�oS
Is the property in question:
❑ Real Property ❑ Mobile Horne QC 61.1-
_ �s��'
7y3
What Taxing trict? Has this deduction been requested on
property for wrrent year? � Yes� N�
COUNTY AUDITOR
��/l��
County Auditor
� 20 �� 20 �� 20
P � �
Date
I/ We certify under the penalty of perjury lhat the above and foregoing infortnation is true and wrred and that the applicants was / were
a resideni of Indiana and owner of the aforementioned property on March 1, 20
iignature (owners full name) Person auihorized by duly executed Power of Attomey
J/_ � � ..^^ I,� orbylC6-t.t-12-.07 ,
R ��c Ql��
address
of authorized person