HomeMy WebLinkAboutMortgage_Kermode f x . STATEMENT OF MORTGAGE OR CONTRAC �E{TED S County Township Year
FOR DEDUCTION FROM ASSESSED VALUT 0f9 �J
rv " State Form 43709(R11/609) •
•
Ptasa'bed by Department of Local Government Finance MAR 11 2013
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the co where is located. Forth filed
with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is County Auditor
2)Mobile/Manufactured Homes not assessed as Real Pm Ot I • Int to S9(Ttponths
before March 31 of each year the deduction is sought. ❑ County Recorder
See reverse side for-d,f".nal instructions and qualifications.
Applicant(owner. b.ct buyer-see restrictions on re side)
eA,e3 .L - 0M/Y'
a D' Key nu / ascription Record mbar Page number
Q ro-ra-/7- o-OD/ ef26-Gb27 1a (-1--)kl-/
Assessed value of real property as of =age/ • Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year 1.co?d '.s f-� /�\ date of epp�catron legal a equitable owner?
4 b000 ❑ 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 applicant.indicate below: Is Me property in questrm:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller Si
mortgagee of tgagee or contract seller(number and street ci state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street tlry,state,and ZIP code)
Does applicant own property in any other I If yes,what county? What Taang District? Has this deduction been requested en property
county in Indiana? =rent Yes ❑ No - for rent year? ❑ Yes ❑ No
COUNTY AUDITOR
Deduon approved In the an— r O 91° .
ca
20_� �� ' 20 20 20 20
1'1'b•r
O ry\.•'• _L..il County ( r)// l
....// r .• ..dt the a bove'andifo��regoing information is true and correct and that the applicant is a resident of Indiana and
r 1)` • ...Waned property on date application is filed.
` ili 1O• Date(month,day,)ear)
Xi r runt"'A �� .a cant(number and street,rely,state,and ZIP code)
/D 1616 o e (sass �(21�eT0 -J Z' c 7 (g7 0
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)
,NI?