HomeMy WebLinkAboutMortgage_Leffler (2) !` z , STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION _
'+i t State Form 43709(R11/6-09) 1 i
Prescribed by Department of Loral Government Anance - I!'1
Fie ra 'i� ' .
INSTRUCTIONS: tt ydu1
To be filed in person or by marl with the County Auditor or County Recorder of the county where the property is located. H � Q 13
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought Court Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)months n' I❑ ry
before March 31 of each year the deduction is sought �_)__I• au er
See reverse side for additional instructions and ualifications. GIB$ �IYii fu,
p ON COUNTY°UOITOR
(owner Or contract t CV side
Ta " District Key number/Iegal tlesa at G7Ctif ee Record number Page rwmber
/b / -/f - /o/ - oo0. 97v _ 00ol a °/3 / 8 / /A
Assessed value of real property as of I Aht gage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the endr�nt the sole
March 1,amen year dr 1,aurem year date of application legal or equitable owner?
/(7000 ❑ Yes El No
If no,what is his/her exact share at interest? if owned with someone other than spawn,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
6-611 /L
Address of mortgagee or contract seller(number and street city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Add of assignee(number and street city,state,and ZIP code)
v Y r 6/7 / r
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ No ❑ Yes ❑ No for anent year?
❑ yes (�
COUNTY AUDITOR Drawer NO.. Q.13.
rrirn
Dedu approved of the amount of: J��j J
20 20 20 20 Card NO. /'�I `gi`a —
Sync ol County AWitar , - County ILJ,l-l.Cl. co�iO
/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.
Syrawrcjawtols/u0 name) Date(rtxxdt,day yr)
A „/ M et
X Frill3ident cell caw of a t(numbera city,state,and ZIP code)
et s //5D t g,4/e/9".41 d , itx /7G6v
Person authorized by duly executed Power of Attorney or by IC 6.1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) •