HomeMy WebLinkAboutMortgage_Beckman STATEMENT OF MORTGAGE OR CON E TEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED ALUATION .
Y!`-l. State Form 43709(R11/6-09) MAR 26`2GS3
Prescribed by Department of Loral Government Finance
File Mark
INSTRUCTIONS: I • I aj
To be filed in F!-',•.C' Form filed with:
person or by mail with the County or County Recorder o q :i ty is located.
Filing Dates: 1) Real Property Must file during the year for which tteigkeett I it• t ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real roFt"perfy:Must file during the twelve(12)months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications. - --
Appfxant(owner or contract buyer-see restrictions on reverse side)
/� (( '7 [� J2rnts 6 S . &c k.rnc.n
Taxing C DAmX�ti La tad a O II(X) � (0 5 � Qo Record nu Page is
Assessed value d real property as of Mortgage/Contract udebtedness unpaid as of Mortgage/Contract' ebtedness unpaid as of Is the appfican!/ntt the sole
March 1,anent year March 1,cement year date of
9 application
legal or equitable
J , ()CC o<Jr cr< ® Yes 0 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 contract seller
as / /44I''cTA( (j�
(rt t _
Address of mortgagee or contract seller(number and street dy,state,and ZIP code) _
lot /JCL) 4'41 :5+, 1 44-`_p•---- - — i 411o3
Name of assignee or other owner or holder a— r �L /nAi'
Address of assignee(number and street,sit) �;l\
�'l i
Does applicant own property in any other /�� Has this deduction been requested m properly
county in Indiana? VVV��' - for anent year?
❑ Yes 0 ❑ Yes ❑ No
_ COUNTY AUDITOR
Deduction approved In the amount oh
20_ 20 20 20 20 20 20
Signature of County Auditor County Date(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)contract buyer of the aforementioned property on date application is filed.
Signature(o : j ::.:) Date(month,day,year)
Full t ad• of a.• , /�3—/�/�
(number. .street cel:state,and LP code)
fl t t 300 S U.4-rxtArv..Z Wi
P- '• authorized by duty executed Power of Attorney or by IC 6-1-1-12-0.7 J . _ Date(month,day,year)•
Address of authorized person (number and street city,state,and ZIP code) -R^`