HomeMy WebLinkAboutMortgage_Lamey (16) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS fri Township Year
%Y
' FOR DEDUCTION FROM ASSESSED VALUATION �State Form 43709(RN/6-09)
Prescribed by Department of Local Government Anance '-
File Mark
INSTRUCTIONS: APR 15 I,.filed with,
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought runty Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(72 ./m ty
before March 31 of each year the deduction is sought. V 1'iy 'Wolter • County Recorder
See revers e for additional instructions and qualifications. GIBBON COON
Applicant r rest ict ons on reverse side) _ -
Ta ' District Key number I legal d • , Record number.... Page number
A - 1.3 // - d-oo - oo / . Los-oa. 2.ol 38 ?
Assessed rahre of real property as of Abnpage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sore
March 1,current year at i,current year date of application legal or equitable owner?
62 poO ❑ Yes ID No
If no.what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobde Home(IC 6-1.1-7)
Name of mortgagee or contract seller 6
—
Address of mortgagee or contract seller(number and street,city,state, nd ZIP code) - - - -- ^
Name of assignee or other owner or holder of mortgage )n '1 D
Drawer NO w
Address of assignee(number and street,city,state,and ZIP code)
Fr C. pE a - 9 -10 A . 00 4C ^ 1
Does applicant own property in any other If yes.what county? What Taxing District? Card NO. .....'D
county in Indiana?
❑ Yes 0 No
COUNTY AUDROR
Deduction approved in the amount of:
20 20 20 20 20 20 20
`
Signature of County Audits - 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.
(owner's Al!name) Date(Hoorah,day,year)
IT i on,-.M a t0n-n
Full r8sident address of a• t(nu r nd • i • sta Yerd ZIP code)
rl- --• •• if t • ■
Person. ,.• by duty ex Power d or by IC t.t-? 7 ^ Date(month,day,year)
Address of authorized person (numbed'and street dry,state,and ZIP code)
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