Mortgage_Taylor (5) a; STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
Cciiii FOR DEDUCTION FROM ASSESSED V T
,! 't State Form 43709(R11/609)
v Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: n�R q r1�n'1 Fon Il •
To be filed in person or by mail with the County Auditor or County Recoreer o £orb !I M'here the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. County Auditor
2) Mobile/Manufactured Homes not assessed as Real P rty Mus file • twelve(12)months
before March 31 of each year the deduction is sought. ❑ County Recorder
See reverse side for additional instnrc tiwcs and quafdxations. (MRSON COUNTY AUDITOR
Applicant(owneror rer
revue)
• Olin COO
T ' Dth� Key l legal R�7 I Pie 9
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Assessed value of real properly as of
Mortgage w/CC����p1trtact indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mash 1,current year Marti I. t.V date of application legal or equitable ownet
�D
rilSoo ❑ Yes ❑ No
If no,what is his/her exact share of interest? 1 If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant.indicate below Is the property in question:Annually Assessed
cop ❑Real Properly ❑
-3-1 13� �G Annually Assessed
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller 5 3
Address of mortgagee or contract seller(number and r' .'t.,rcity state,and ZIP code)
Name of assignee or other owner or holder of r
•
•
Address of assignee(number and
(9\. ....\
Does applicant own property in a/ /V\ what Taxing District? Has this deduction been requested n property
county in Indiana? / (Vr�� far current year?
[� ❑ Yes ❑ No
/ s"
/
..O. • COUNTY AUDITOR
Deduction app �
C'`. {V,
-
20 \130\ 4 20 20 20 20
N.
Signature o, r•':� ' n County Date(month,day.year)
�l 'yirrV,`-/�--rye_
I I We certify urn... .erjury that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/ d buy. .rementioned property on date application is filed.
����OEChrd M/y(mp)a) / 1/ / �/ Date(rrmwuh.day,year)
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Person authorized by duty executed Power of'.- `by 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,state,and ZIP code) .