HomeMy WebLinkAboutMortgage_Spurgeon STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
l' State Form 43709(R11/6-09)
Prescribed by Department of Loral Government Finance
le Mark
INSTRUCTIONS:
To be filed in person or by mad vnN the County Auditor or County Recorder of the county where the property is local F
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. Court uditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months yII��I
before March 31 of each year the deduction is sought. A R 1 0 ,Gvjtgty Recorder
See reverse side for additional instructions and qualifications. 11 VV LU IJ
Applicant i..-nor.. a.Duyer-see -`r, side) \
Taxing Oise a py number/legal description $ C ; -. III, M�rlif�
o(�o - L -18 - 30 -OD•+ S3D -007 Q /-3Ij$�
Assessed slue of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the sepfrant the sole
Mardi 1.assent year Maras 1,anent year date of application legal or equitable owner?
Ogd 552) 0 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 a different than that of applicant.Indira w r Is the property in question:Annually Assessed
^ ❑Real Property ❑MnuallyAssessed
r Q` Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 1/4- CLOVI
Address of mortgagee or contract seller(number and street,cdy.state,and ZIP code)
Name of assignee or other owner or holder of mortga --
Address of assignee(number and street,city,state,a 070 /]�{o O,
Drawer NO
Does applicant own property in any other �y ^/�, Has this deduction been requested on property
county in Indiana? / 3 !2.. for moment year? ❑ Yes
❑ Yes ❑ No Card NO. i/�/�\).</ ❑ No
Deduction approved In the amount of 67) VSO%t/ `�
20 20 20 20 20 20 20
Signatu of County Auditor County Date(month,day,year)
I/We ce A. nder the penal r of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
own: .antra. buye of the aforementioned property on date application is filed.
e`...(ovine s. n nt.•i) Date(month,day year)
a e 1i- 114143
FWI en - oha•• 'n a.• .-4 aty;state,and LP code)
3t tJ 1 QLU?660
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 sbee;city,state,and LP code) . I�
\Y