HomeMy WebLinkAboutMortgage_Baehl (4)F- STAThMT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
j" Stale Form 43709(Rii/6-09)
Liz D
Prescribed by Department of Loral Government Finance
F I INSTRUCTIONS:
Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is boated. I P R 2 'lI[n Id
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must fife during the twelve(12)months
before March 31 of each year the deduction is sought. ❑ County Recorder
( • 1
,
See reverse side for additional instructions and qualifications. a Irrirrililitili
Applicant(owner or contract buyer-see restrictions on reverse side) GISSONCOUNTY AUDITOR
al.( Jercn, a. • i Qt,-tit P. s-,I Re.ccoisir. L'rViA5 Ln.S4- c.&/A O(r- to-z-c(-76
Ta ' 13" Key number/legal description Record nu Iumbtr
d(o- 8-36-503 o/a ao �Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage Contract indebtedness unpaid as of Is the t the sole
March 1,axreat year March 1,cement year date of application comer?lication legal or equitable comer?
39, cult). Co) : 1,c-,co.OC) ❑ yes ® No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
L c': 5-1cA , crane d IN 'k vc.,,,e. (Mt 4,4, u.?_ir I
If name on record is different than that of appfrant,indicate below: Is the property in question:Annualy Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller !f (� r�
bet-waCtn Monet;can FA:n .r r P
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
-711 Main S+n PO DX 3&O J2Snv✓Te'-4-1-. .. a3uO
Name of assignee or other owner or holder of mortgage i ----r—
Address of assignee(number and street,city,state,and ZIP code) \
i
r)0.E
Does applicant own property in any other If yes,what cou _ �,,r� Q.. S t been requested on property
county in Indiana? �'l lT` - 13 J I v ❑ yes ❑ No
❑ Yes 0 No \Y``
Deduction approved in the amount ol:
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
Amer I contract buyer of the aforeme 'oned operty on date application is filed.
sir (o Mina -) Date(month,day,year)
y(z1?29 r3
W
p den..r;'' -of:y t mbar a street,city:state,and ZIP code)
Person..thorized by duty executed Power of Attorney or by IC 6.1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .