HomeMy WebLinkAboutMortgage_Stevens (2) a-:�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
-e'"` f" State Form 43709(R11/6-09) �@.".'�� I
'-.±.--'',. Prescribed by Department of Local Government Finance
1 e ED
INSTRUCTIONS: 1 1 l
To be filed in person or mail with the Coun Auditor or County Recorder of the county where the property Form filed with:
Pe by ry ic tr p pertyislocated.MAR 1- 0 3�
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. my Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file during the twelve(12)months
before March 31 of each year the deduction is sought. /�� cum ecorder
See reverse side for additional instructions and qualifications. CIQG Nt'
Applicant(owner or coneast buyer- restrictions onre side • trtl)TOK
iii District Key number I legal deicrip Record number Page number
a6 - /a o� - io3 -ooa . o �� — � � 8 �. 3 (* 7 /
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,greet year Marry 1 cement year dace of apPOCation S Iegal or equiable owner?
If no,what is his/her exact share of interest? If owned with someone D D ❑ Yes ❑ No
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 setie
Address of mortgagee or con seller mber and street,city,state,and ZIP code) Gi l A 1 i 173 r0 -y�
Name of assignee or other owner or holder of mortgage J f G�GfL�/ELI - 471
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Ad of ( mlms7 .slate, ZIP code)/ /z l - 0/1 � T/s fl
Does applicant own property in any
other tf yes,what county? What Taxing District?
county in Indiana?
❑ Yes ❑ No I ,_, „_ _
COUNTY AUDITOR
Deduction approved in the amount of
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20 20 20 20 20 20 20
Signet of 4 4oG'/xr .... .. 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 I contract buyer of the aforementioned property on date application is filed.
• Signatu a(owner's NII name) Date(month,day,year)
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�[ FuII resident ad of applicant(number and sheet,dry, te,and ZIP code)
' ` 313 6J ,1/x4//V a 4- ,s-1- Pr,Nc t+0 iJ _r t/ 4'Ili 70
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year) r
Address of authorized person (number and saes;dry;slate,and ZIP code)
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