HomeMy WebLinkAboutMortgage_Partenheimer (2) a. STATEMENT OF MORTGAGE OR CONTRACT EkEIrt County Township Year
FOR DEDUCTION FROM ASSESSED VALU
I'. State Form 43709(R71/6-09)
Presvibed by Depetn/n4 of Local Government Furore
MpV g 7�, File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county ere(he dr••,d4 is located. Form filed wtd�
Filing Dates: 1) Real Property:Must file during the year for which the deduction is soughaf s%mm1T OR la County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file•'n' r t months
before March 31 of each year the deduction is sought GIBSON C' ❑ County Recorder
See reverse side for additional instructions and qualifications. r� /�/
Appfrtanl(owner oLrpntracf buyer re o 2-re A'
\`�f` .fit err vn )
Tariing9y�a Key number/legal desorption number
rd number Page numb
� man a6-/.2 -06 -id'-/-w2 . o 947 -oak co/ 6 37Q
Assessed vale of real progeny as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Moth 1,current year March I // date of application legal or equitable owner?(07 7 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant,indicate below: Is tpR property in question:Annually Assessed
Property ❑Annually Assessed
• / Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
0145
Address of mortgagee or contract seller(number and street,ray state,and ZIP coda)
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Name of assignee or other owner or holder of mortgage �/�,y�) ,,�"/1
Address of assignee(number and street city,state,and ZIP code)
Drawer �1Q.CVO/f r/1
Does applicant own property in any other I If yes,what county? . - . • equested on property
county in Indiana? ❑ Yes ❑ No /)
Card NO. ...1137 a ❑ 1:1 yes No •
Cap 4 61,314/. °?
Deduction approved in the amount of.
20 20 20 20 20_ I 20
Signature of County Auditor County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contact buyer of the aforementioned property on date application is filed.
Signature(ovine tub name) / Date(month,day,year)
Y Gl.��-A I Ca .5- 3'- /3
Full resident address of applicant(number and street city state,and`tZ.l�,,d°,e) ) 9��"
/a /3 N ova 7 /Gl/YLar�7J \_/n '%7/0 76
Person authorized by duly exearzed Power of Attorney or by IC 6-1.1-12-0.7 Date(north,day,year)
Address of authorized person (number and street may;state,and ZIP code) _