HomeMy WebLinkAboutMortgage_Kirkpatrick (2) STATEMENT OF MORTGAGE OR CONTRA►,? E TE R
�.��.. /• County Township Year
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t-,- FOR DEDUCTION FROM ASSESSED VALU;' I
-4-- t- State Form 43709(R11/6-09)
l'71-1I-t: Prescribed by Department of Local Government Finance
MAR 12 2013 File Mark
INSTRUCTIONS:
Form filed with:
To be filed in person or by mad with the County Auditor or County Recorder of the....0) whe 4 he.s)., •is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction i yell.; County Auditor
2) Mobile/Manufactured Homes not assessed as Real Pro 3-d 7"..fropyribironths
before March 31 of each year the deduction is sought. County Recorder
See reverse side for additional instructions and qualifications. -
Ap. :Us owneror contract buyas- resm'rbons 0side) • _r L
a rgr� Vain Key number/ description N number Pag number
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Assessed?due of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract inde tress unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
// q 00 ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
ff name an record is different than that of applicant,indicate below is the property in question:AnnualyAssessed
"�- I Property ❑Mo 1.1-7)
Name of mortgagee or contra leri-- r..e `\\\ _ -
Address of mortgagee or contract seller(number and street, state,and ZIP code) _ r'\
c .........
Name of assignee or other owner or holder of mortgage 1\\,C r O,
Dr.
Address of assignee(number and street,city,state,and ZIP code) , 1 /'X
Does applicant own property in any other If yes,what county? What Toxin
4a0 +h
county in Indiana? O �M
❑ Yes ❑ No /r 11 t1cc �• 1 No
fir ,�i� allots COUNTY AUDITOR( - _ _ a I
I:uction approved in the anvil of
20 20 20 20 20 20 20
Signature of County Auditor I County 1 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.
Sig awrle/s rail 11. ,n0 Date(moth,day,year)
t\!]/_ '` off(numbe -I! /; h 1,1 �r
an/ / 7 Fieem'l' IX 4P//��s-riW l/ - iv 7 7 639
P a by duly executed Power of y or by IC 6r1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city;state,and ZIP code)