HomeMy WebLinkAboutMortgage_Walker (6) STATEMENT OF MORTGAGE OR CONTRACT INDEEJNJS?S .i�' Township Year
'1 FOR DEDUCTION FROM ASSESSED VALUATION
X' f'- Slate Form 43709(R11/6-09)
Prescribed by Department of Laval Government Finance JUL 1 9 12
File Mark
To Med in NS C.herv\�
To be filed in person or by mail with the CowryAUditw or County Recorder of the county where the grope is ted. Form Ned with:
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is soxggtr, 17eY County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Me?,9 (P2Prpa Eft
before March 31 of each year the deduction is sought. County Recorder
See reverse side for additional instructions and qualifications.
Appfrant(owner or con buyer-see restrictions pn rd0O
Taxing ¢trr4 S Key number/legal) description Record number Page number
,j- a6-/ 9-3/ -Ail a? 06° 7/02- DO? ,Rol a _35[51
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app i ant the
March 1,anent year Mardi 1 wrtgn year date of application
legal or equitable owner?
(7J(J/�C� ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate who whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annually Assessed
IUpal Property ❑ y Assessed
- Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract sener I f/ 7-
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)
Does applicant own property in any other If yes,what county? What Taxing District? for current rear been requested on property
county n Ind" ❑ Yes ❑ No ❑ Yes
❑ No
/3 COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I 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.
Signaeue hill") r, 0�) Date(month,day,year)
Full resident address of a t(nu bee and(stree/ee4 city,state,and ZIP code)
A 3 n i Lf- /,t_.(�-e-. �1 , _zit/ 4/ x 7 2
Person authorized by duly Attorney executed Power of Attoey or by IC 6-1.1-12-0.7 ate(month,day,year)
Address of authorized person (number and street c%state,and ZIP code) .