HomeMy WebLinkAboutMortgage_Donaway (2) } STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDN I ou ownship Year
F_-� 1`L
,;: FOR DEDUCTION FROM ASSESSED VALUATION
l- State Form 43709(R11/6-09)
_, Prescribed by Department of Lod Government Finance
41TRLIC770tis: JAN'2 51013 File Mark
lb be filed in person or mail with the Cow Auditor or County Recorder of the county where the property Foy N� '-
P by County ry ty P perty is located.
Filing Dates: I) Real Property.'Must file during the year for which the deduction is sought. ,; • I e. ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twely- �i.�,y •in:rirint1/1
before March 3101 each year the deduction is sought SON COUNTY A JDI li➢R bounty Recorder
See reverse side for additional instructions and qualifications. C
Appor(owner or€bact buyer restrictiorss on rew+se sde ry . /1 iJ je,
Crflat is ' strht Key er/ ptan p/� Rem ny r Page number
�bni,,ng7 rtmd ) / 637-oaf 9H ( _
Assessed vWUe of real property as of ortgage/ Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Marc 1,current year 1a�1,mrtrrn year date or apPOrstion legal or equitable orrtrer7
❑ Yes ❑ No
If no,what Is his I her exact share of interest? If owned with someone other than spouse,indicate With whom
If name on record is different than that of appliicant,Indicate below: I ttI��s the property in question:Annually Assessed
IT.Llteal Pmpety ❑Armualy Assessed
r� MoNIP Home(IC 6-1.1-7)
Name of nnrtgagak�mnbad er _
Address of mortgagee or contract sell n caber and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage —_ - -
ffry
Address of assignee(number and street city,state,and ZIP code) `.J:-%1`ey U(,.kJ Ai l a `
Does applicant own property in any other If yes,what county? • EIrnri.'r A A�-C•1`s"` on property
county in Indiana? ❑ Yes ❑ No
❑ No
® COUNTY. 13--1/�
4 f,
Deduction approved in the amount of.
20 20 20 20 20 20 20
Signature of County Auditor County Data(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature o es full name) Date( day,year)
Ij5 .201.3
ent address ofa t(nu rand street,ray. te, code)
11° AD,ISO . 4 amp' TN HTh10
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 t Date(month.day,year)
Address of authorized person (number and street,city,state,end ZIP code) •