HomeMy WebLinkAboutMortgage_Courtright STATEMENT OF MORTGAGE OR CONTRACT IN ES "?my Township Year _
� , FOR DEDUCTION FROM ASSESSED VALUATIO! �
.::. f" State Form 43709(RD/6-09)
-- Prescribed by Department of Local Government Finance 1 ass
MAR 2 File Mark
INSTRUCTIONS:
Form filed with:
To be filed in person or by mail with the CountyAuditor or County Recorder of the county whe-' he p •_'�c-..located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. I. ' -d �.• nr�g��f(y1 unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Muss • a . :$ v:••41127mb/RA5'R
before March 31 of each year the deduction is sought. County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see on side) //
V � p��p/� C�/L/lU
Taxi AO 4 `! ' Key number/legal description Record number Page number
.f/iri-12M r���9�9-,7o gar' l r-2 7-oa �/J ao i 3 /3
-_T.•, -rd real as d Mortgage/Contract indebtedness unpaid as of Mort gage/Cantraoinaebtedness unpaid as of Is the apparant the sole
March 1,ascent year March 1,current year
❑ Yes ❑ No
ar date of appUcabon legator equitable owner?
rn T
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 applicant,indicate below: K,.. •operty in question:Annually Assessed
1910-4 Properly ❑Annw^Assessed
M " e(IC rrl.la>
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and scree;coy,state,and ZIP code) /
Name of assignee or other owner or hoder of mortgage .
•
Address of assignee(number and scree;city,slate.and ZIP code) ♦O• •• ma " •
J • 9
Does applicant own in any other If \
Pa1° property y yes.what county? What Taxing District?, �C� a -don property
county in Indiana? ❑ Yes ❑ No o• ❑ No
-9 -,`.Q�\��j Yes
COUNTY AUDITOR \^•b
Deduction approved o the amount of ' G•
20 20 20 20 20 I 20 20
-,
9
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.
•na - •wner's Ng name) Date(month,day,year)
P
ail resident address of applicant(number and sheet ary,statezfiod ZIP code)
X 3o6"-- c 730 S /'or-A l -c..cA ,SA/ 'f>65'A
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) 1.41
Address of authorized person (number and street Cy,state,and ZIP code). \`