HomeMy WebLinkAboutMortgage_Enyeart (2) '_f STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coF I LT 1:;\
.D"Year
--•1 FOR DEDUCTION FROM ASSESSED VALUATION
'44.41-
f- State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
•NSTRUCTIONS: F : Imatt13
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located Form filed wider
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. I ,ri; .tidier
2)Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months •-`
before March 31 of each ( ) 'i 'I✓n' fir
year the deduction is sought GIBSO C��
See revs a side for additional instructions and qualifications. GIBSO
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MpGgnt weer ar rl buYar r ( Oo^L/� e/ C.1/�-•
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Assessed value of real prepemy as of =aye/Contras indebtedness unpaid as of Mortgage/Contact Indebtedness unpaid as of Is the aPP t Na sole
Mardi 1,current year March 1 cwrem year date of applirati/,)00:0 legal or equitable 0 N
❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
•
If name on read is different than that of appnrant,Indicate belaw. Is property in question:Annually Assessed
Real Property ❑Nmually Assessed
Mobde Home QC 6-1.1-7)
Name of mortgagee or contract seller 3
Address of mortgagee or contract seller(number end t,city,slate,and ZIP code)
Name of assignee or other owner ar holder of mortgage ��"
2e:)//7 arm. s o?"y4 c3"---
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? I —----nested on property
county n Indiana? ❑ Yes
❑ No I Yes ❑ No
i c, E N\lEA-k , WEaro � I
Deduction approved in the amount of:
20 20 20 `-"' 20
Sigratwe of County Auditor I Fla f ti yn, ts) ,3ADI Year)
I I We certify under the penally of perjury that the above and forego! N /9 000- lent of Indiana and
owner I contract buyer of the aforementioned property on date appli ft I
SignpN re(owner's hull name)` yeah
llrr� t CiN,n .trand .� I / 31 I
Full resident address dapp0art(mm rand street,ray;state,and ZIP COde)i I
IaS £ MoQi zt ST PlleINCi i-o
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I - • - - -:Year)
Address of authorized person (number and street,city,state,and ZIP code) I