HomeMy WebLinkAboutMortgage_Patterson (2) eLle, STATEMENT OF MORTGAGE OR CONTRF�IDBT � County Township Year
�- FOR DEDUCTION FROM ASSESSED VAL I N>I.�
State Form 43709(R11/6-09) •
— Prescribed by Department of Local Government Finance 2 9 2013
JAN File Mark
411STRUCnoNS:
lb be filed in person or marl with the Co Auditor or County Recorder of the co - -• �f Form filed with:
P by County iy i•ri. "ir::T,•y�"dl'isl K.tail �,{
Filing Dates: 1) Real Property.Must file Homes the year for which the deduction is - puD170 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property: a AlieFze(}2)months
before March 31 of each year the deduction is sought GIB ❑ County Recorder
See reverse side for aoddiitio+naall instructions and qualifications.
APMuant(�wrerl/C /(QAY G� a/L1)ceni
// Key number/legal description Record number Page number
G? -/a -o7 o/ er0 I036oa2A ao08� I 5y
Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appfiant the sole
Mardi 1,current year March 1,current year date of application legal or equitable owner?
❑ 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 record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or Contact stager
Address of mortgagee or contract seller(number and street,city:state,and ZIP code) •
Name of assignee or other owner or holder of mortgage
-- __ _ •
Address of assignee(number and street,city:state,and ZIP code) . _-_ a7150
Dces applicant own property in any other If yes,what county? D r a wer NO requested on
county in Indiana? property
❑ Yes ❑ No (�
5/ El Yes ❑ No
COU
Card \O• g
Deduction approved In the amount at
20 20 20 20 m 20_ 1 20
Signature of County Auditor County Date(ninth,day,)ear)
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. -'
ire owner's yaf,7 Date(morvh,day.yea/)
Pun resident address of applicant(number and street ugly,state,and ZIP code)
K3/( S HRLL < T rtrn/rf-ro i ry 476 -70 -
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .