HomeMy WebLinkAboutMortgage_Ritter (4) 41,:-.V1 STATEMENT OF MORTGAGE OR CON 7,.- I ! ', .. County Township Year
)1: FOR DEDUCTION FROM ASSESSED V 11 I N
State Form 43709(R71/6-09) �.J
Prescribed by Department of Local Government Finance
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INSTRUCTIONS:
MAR 2'6 2013 File Mark
To be filed in person or by mail with the County Auditor or County Recorder of the county where t e pro arty is located. Form filed
with:
Filing Dates: 1) Real Property Must file during the year for which the deductio sou 7.
County Auditor
2) Mobile/Manufactured Homes not assessed as Real Prope twelve 02)months
before March 31 of each year the deductiionissougf�flgSON COUNTY AUDITOR County Recorder
See reverse side for additional instructions and qualifications.
Appfican(-(pwner or LICIl6uyer-see�s1rMAOns m rt"vprse 5iY @)
TaxiiM DDiiStlict(.y�`I_)—p`•'�"�`'`A't1{( Key number/legal description Record number Page number
11 \ �� a tor tl— t9— LOC) 000qa. coal (-3.0) 3 1 7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the
March 1,anent year March 1,7a nt year y(�\ date of application legal or equitable owner?
e
/ V Ly-�/ ❑ 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 is different than that of eppfcant,indicate below: Is the property in question:Annua%Assessed
❑Real Property ❑Arinualy Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller C
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Address of mortgagee or contract sager(number and street,city,state,and ZIP code) ., r�}� -
F-�
Name of assignee or other owner or holder of mortgage j� I t I C�t J
Address of assignee(number and street,city,state,and ZIP code) /5 _ / /C
Does applicant own property in any other If yes,what county? /// ed on property
county in Indiana?
❑ Yes ❑ No !es ❑ No
COUNTY I
Deduction approved in the amount of:
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.
naW rY ame) �•i/ i>./f�(,�1�'' ) I 1/7665-Date(month,day,year)
o-dent
! ( S S, 0111-442. /bSr/!i�/C^CX!/C�J.��G�'`/IDwowsui a._ ) I
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 .tai' Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) i 4\•
1