HomeMy WebLinkAboutMortgage_Sander (3) IS
f`}.At STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun It E ;aRirw
FOR DEDUCTION FROM ASSESSED VALUATION
t" State Form 43709(R11/609) _1 • -__ _�.
Prescribed by Department of Lod Government Finance -_ Mill
File .
INSTRUCTIONS:
To be filed in person or mail with the County Auditor or County Recorder of the county where the property Ft . wm �i
Pe by N ic ry P Pottyklocated. %^lf/�r,
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. a ,,,4�: �lnr
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)monta I BSO N t_-U ` b Ii 1 I OR
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 restrictions on reverse side)
( t Cnr l0. L. - Irmac
Ta istrirl Key number/legal description Real.rd number Page number
h. n 1�'�-i�,oe- Gf',03- oo1/a/-od8 ! o7-3 /S
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the
March 1,=rent year March 1 current year date of application Iegal or�eputtab a owner?
/5�, cw. CO /S%OCO ® Yes ❑ No
If no,what is his/her exact sham of interest? If owned with someone other than y=ea,indicate with whom
If name on record is different than that of applicant,indicate below:
Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller n (�
the_r 'an 1'(�1( er;can Ennco'o
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
D &' •1d-) 7/I ( 11/4 a Jasper _Li q-Is LI-I-036o
Name of assignee or other owner or ldder of nnrtgage
Address of assignee(number and street ml:state,and LP code) -ia /�/ ' � /� �r
Does a; _— 1i What Taxing 13— Has this deduction ctionn been requested on property
1 W4 for anent year?
in L �1'1 � `` El yes ❑ No
i I ' I AUNTY AUDITOR
Deducial /) /\/L3....
-
20. (�/-•C`(„f iSI4 PID 20 20 20
Sgna ccJJ County Date(month,day,year)
1//f /r,
er a pe . of perjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner I contra. buyer of the aforementioned property on date application is filed.
Signature(/e • name) Date(month,day,year)
FaL� i�� L' / ems code)
4/�✓. _i!/ 3 - • 43
tr. authorized by duly e -•ted Powys of Attorney or by IC 6-1.1-12-0.7 'Date(coon ,day,year) (�
Address of authorized person (number and street,sex state,and ZIP code) _ t