Mortgage_Hopper 7
STATEMENT OF MORTGAGE OR CO CT INDEBTEDN I ou ownshi Year
t ; A FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Lo®I Govertunerd Finance File Mark
`37RUCTiONS: JAN 2 5 2013
To be Red ho person or by mall with the CounlyAuditor or County Recorder of the county wham the Farm fled
ty property is boated.
Fribg Dates: 1) Real Property:Must file during the year for which the deduction Is sought. e 0 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must No during the twe . U.;.r •:rir4enlir
before March 31 of each year the deduction is sought SON COUNTY AJDIWRCounty Recorder
See reverse side for additional fnsirueNons and qualifications. C
npoa/q/p(owner '�r�-/ )m tictions co reverse aria /(',y pj
y-r �r/ crii° ,,, ` � 6 O1T 0/21, .
T Key number/ 'peon Page number
/P)- -7nO ��) / 6,37 -Oaf 4402
Assessed van a(reel properq as of { unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the epp0®rd the sole
I.anerd year M1terrh i,amend year date of eppemtkn legal or equitable owner?
❑yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,McDade with whom
If nano cm record Is different than that of epee:ant,Indicate below. {ttttIIss,,,,...t...h___ee property in question:Annually Assessed
eal Property ❑Annually Assessed
11 Mobile Home(IC 6-1.1-7)
Name N moryarat m /
Address of motgmo tgagee/ a contract xde. n and street ay,stale.end ZIP code)
Name of assignee or other owner or holder of mortgage � /�
Address of assignee(number and street city:state,and ZIP code) C.,7..,1/C 6 Ott I,,/R urA"i
Does applicant own 1..
property in any other If yes.what county? . " '1 A A Alms � On Property
m Indiana?`
county In Indiana? ❑ Yes ❑ No z ❑ No
COUNTY i3'L1L1C\
Deduc9m approved In the amount of:
20 20 20 20 20 20 20
Signature of Canty Auditor County Date(root 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/contract buyer of the efwenientioned property on date application is filed.
o MI on)
Date(1 251,,203
ant add/asset applicant(mastrarand street rdr. )
110 naDik 1 (1(1a- i 7N (-11(67()
oauthorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month.day,year)
Address of authorized person (number and street city,state,and ZIP code) .