HomeMy WebLinkAboutMortgage_Walker (6) }T. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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�,;, FOR DEDUCTION FROM ASSESSED VALUATION
``' �' State Form 43709(R11/6-09)
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Prescribed by Department of Local Government Finance
INSTRUCTIONS:
To be filed in person or mad with the County Auditor or County Recorder of the county where the Form filed with:
pe by ty ty ty property is rotated. 3 Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. MAY 3 D10130unty 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 ❑ •unty Recorder
See reverse side for additional instructions and qualifications. 4I mA4
Appecanl(owner or contract buyer-see on use side G IbSON COU I IY AUDI FOR
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,T -awg District f Key number/legal description Record number Page number
7fi0-IJ�th%t- Y/- e2 (n - / 9 -36-30_3 -o co. 7 (19-00? o i3 /3 f7
Assessed value of real property as of I Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,°rent year Mardi 1,current year date of application legal or equitable owner?3 0 0 00 6� ❑ Yes ❑ No
If no,what Is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is efferent than that of applicant,indicate below: Is the property in question:Annuafy Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1-1-7)
Name of mortgagee or contract seller J/{A di__ //
Address of mortgagee or contract seller(ru end street,city,state.0 VP PPo'C)
Name of assignee or other owner or holder of mortgage
Add rp of assignee(number and street,city, tare,and LP code) , i A S l ---
Does applicant own property in any other If yes,what county? • What Taring District? ______ Vas this deduction been requested on property
county in Indiana? ❑ Yes ❑ No r- wcrrrent ye ❑ No
❑ Yes
COUNTY AUDITOR Deduction approved in the amount of:
DIa wet. NO...a®/ 3 -
20 20 20 20 20 .. ...
Signs of County Auditor • . County
. Card NO. . )S .36
I/We certify under the penalty of perjury that the above and foregoing information is true ac_ -4Togeett 3/Nr —
owner I contract buyer of the aforementioned property on date application is filed. Lam)
/,A. Signature(owner's fu ti r/(�r�y'/A^"''///�l�{I�'1,1i�,{� _
Full resident address of applicant(number and street,rat,state,and ZIP code) • - _ -- - —
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767 E HRh9 .ST. HRUg cM OT/ it-) 5174 3 9
Person authorized by duly executed Power of Attorney or by IC 61.142-01 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code)