HomeMy WebLinkAboutMortgage_Critser (2) t_} STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Cou Alta tapjUIk_Year
�tomt. FOR DEDUCTION FROM ASSESSED VALUATION 'r;
-"`r'�' State Form 43709(R11/6-09)
' .' Prescribed by Department of Local Government Finance
4TRUCnoNS: • JANFI2�aP(113
To be filed in person or mad with the Co Auditor or County Recorder of the county where the property Farmr�filed with:
p by unN N ry p party is located.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. I to-! r Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)mu g%
before March 31 of each year the deduction is sought V ItlSON CO it,Triwereger.
See reverse side for additional instructions and qualifications.
Ap. .+.1( .. • contrad6� re sate) .
/`�N/fAr /�/� 2 ''7 a/9_e�7 fir Record number
T..: .. �stru y i 1Jpmbe//legal 'ption0Q 0— 000. J— 0� / c/26/. Pl0 /lJ'
Assessed value off real(_±^.property as of /VJ, =aye/Contract indebtedness unpaid as of Mortgage I Contract indetttyydeeedddnnness unpaid as of Is the app s the sate
Math 1,current year Mari.1,a rent year date of aPPOretion// w equitable amen
(JX . ❑ Yes ❑ No MO
If no,what Is his I her exact share of interest? If owned with someone other than siese,indicate with whom
If name on record is different than that of apogean!,indicate below. Is property in question:Annually Assessed
Real Property ❑ Wally 1.1-7)
Name of mortgagee or contract seller i////���
Address of mortgagee or co seller(n and street,rte.state,and LP O
•
ntract
Name of assignee or other owner or holder of nsrtgage
•
Address of assignee(number and street,d4:sate,and ZIP axle) ,L y /� — `7/ 7 143
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes El No for current year?
❑ Yes ❑ No
—/��— COUNTY AUDITOR
Deduction appn (• K TT sg / a r p
20_ 7`-�+ f-JIA Y 20 20 20
Signature of Cc I �a'6 /,,a?t County Date(month,day,year)
I I We cent "onnation is true and correct and that the applicant is a resident of Indiana and
owner/co lis filed.
•/
1 Strata"(pvner's tW name}J r Date(month,day,year)
k_1�Wp/011-f+l�i/lily/ r/yr-�'*'/
Full�n In� V1/ applicant(numbe�'�street,o te.and LP coder A / /7 69 76)
l Person//authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 '4(//�L�/ —f Date(month,day,year)
Address of authorized person (number and saee4 city,state,and ZIP code)