HomeMy WebLinkAboutMortgage_Greenwell (3)�► STATEMENT OF MORTGAGE OR CONT
FOR DEDUCTION FROM ASSESSED V,
SMate Form 43709 (R11 / 6-09)
i" presaibed by department of Local GovemmeM Finance
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�TRUCTlONS:
7o be filed in person or by mail with the County Auditor or County Recorder of the co Ii e►ty is located.
Filing Dates: 1) Real Property. Must fi/e during the year for whieh the deducfion is .����p170R
2) Mo6ile / Manufactured Homes not assessed as Real Prope���Ql��t (12) months
before March 39 of each year the deducfion is soughi. �
See reverse side ior additi al instructrons and quafiications.
APplicxnt (owner or contrad e- see re,stric�ons on reverse s�) n„_ ..n / i
File Mark
Form filed With:
County Auditor
County Recorder
. .d - — ey number legal �qscxiPtlon �— � — o � O. /��� �rd n b �� Pag%�� Cl
LiC.
q� �� a¢ prop�y Mortgage/ Cont���tt inde6tedness unpaid as of MorRgage / Contrad indebtedness unpaid as of Is the applicant the sole
March 1, cixrent year Maroh 1, curte��^ O^^ date of appltcation legal or equdaWe owner?
/° C � E�C� ❑ Yes ❑ No
If no, what is his / her exad share qf interest? If owned with someone other than spouse, indicate with whom
If name on record is ditferent than that of appiicaM, indicate below:
Name of mor�qagee or contract seller �/ �/ �,� / I / p/�
L / ��� � vv �
Address of mortgagee or contract seller (number and street, city, state, and ZIP code)
Name of assignee or other owner or holder af mortgage
Address of assignee (number and stree� clly, stafe, and Z1P codP`
Dces aQplipnt own property in any otheC�� unty?
county in Indiana? �
�— ���,�,�1'�Q°�.� ap��. -
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Signatr.� � Y�
WhatTa�dng District?
GOUNTY AUDITOR
20 20 _
� /1 ��ry . �
I/ We ..�y under the penalty of perjury that the above and foregoing information is trve
owner / ntract buyer of the aforemerttionad property on date appiication is filed.
�� _ 1 name) _ �/
u resideM ress of appl'�can� (num6er and street city, shate, and ZIP oode) � J�
b Gs y J' �"o kl 1����vs�� 1!� , •y
Person autho�zed by duly executed Power of Attomey or by IC 6-1.1-12-0.7
Address of author¢ed person (number and s6eet city, state, and ZIP code)
Is the property in ques6on: Mnuaily Assessed
❑ Real Property ❑ ArmualyAssessed
Mobile Home OC 6-1.1
Has this dedudion Deen requested on property
for curnerrt yearl � Yes ❑ No
20 20
_ Date (month, day, year)
corred and that the applicant is a resident of Indiana and
4'�GG
Date (nwnth, day,
Date (month, day, yea�