HomeMy WebLinkAboutMortgage_Reneer (2) iamb STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
t1e" FOR DEDUCTION FROM ASSESSED VALUATION
state Form 43709(R77/e-09)
Prescribed by Department of Lod Government Finance F LE
INSTRUCTIONS:
To be filed in F Ned with..
person or by mail with the CountyAud for or County Recorder of the county where the property is located. 1
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. d 54t4 Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought. - 4 i Coup∎ Recorder
See reverse side for additional instructions and qualifications. ti.,--,.. `a,911,
� 7 �,{"� GIRSON COUNTY AUDI I OR
qp..Int(owner or contract eer,restrictions on reverse side)L(Ja--r_eta, /I te-- --t
Ta'/District ,i Key number/legal description Record number Page number
. . .....A. - - Aa , - -4, - 3097, -620/ 6 V0 - Oa7 9,0 ( 3 1869
. ,.vahie ol real property—ol Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applrant the sole
Martin 1,and year March 1,current year date of application legal or equitable owner?
/ 0/ 000 ❑ Yes El 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 applicant,Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
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eet-tll a F <<-C
Address of mortgagee or contract seller(number and street,city state,and 2/P code)
Name of assignee or other owner or holder of mortgage
Md$ss of assignee(number and street,city state,and ZIP code) — - - -1
rt Sw /- ,i -/f 3, 58 4- lD,aaaa�
Does applicant own property in any other If yes,what county? G What Taxing District? �1
county in Indbna? ❑ Yes ❑ No �/ O
Drawer NO c
COUNTY AUDITOR
Deduction approved in the amount of: Card NO. ....I I
20 20 20 20 20 c..
SignaW of t • County Date(month,day,year)
1/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 I contract buyer of the aforementioned property on date application is filed.
A 519�trye(owners Nil me Date(month,day,year)
// r_
)(Full resident ad of appbcant(number and street,ray,state,and ZIP
/` 1/72 okA Hk Yi N ✓
Person authorized by duly executed of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street cuy,state,and ZIP code) _ (N