HomeMy WebLinkAboutMortgage_McKowen STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
-s"' 1.' State Form 43709(R71/6-09)
Prescribed by Department of Local Govemmem Finance .
- M.
INS7RUC77ONS: i'=•
lb be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located Ii • •I
Filing Dates: I) Real Property Must file during the year for which the deduction is sought. El County 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 - AYE§ .C Recorder
See reverse side for additional instructions and qualifications. / /7 �.��
Appfxant( or oony9a uyer- t- revr�se side) ^ ^_� r/ifJr{�{—�T"'^"p"��r/�
Taring District C_rJlv,[A•C/^4'i- number/ 1 desrnpoan (1_(\ I r l fT12 DN' pety fnbAf
gb- ( C-3G- .3no - � . a43-Oy G '13Nr CQ�.
Assessed value of real pmpey as of Mortgage I Connaa indebtedness unpaid as of Mortgage I Comsat indebtedness unpaid as or IS the appecant t e sole
March I,anent year March 1 data of appficotion legal or equitable owner?
���111111 ❑ 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 appfnant.indicate below: Is the property in question:Annually Assessed
❑Real Property El ArnualyAssessed
• Mobile Hare(IC 61.1-7)
Name of mortgagee or contract seller /�
Address of mortgagee or contract seller(number and sheet riry.— ,and ZIP code)
IlF)•4'J`��1_l�. �
Name of assignee or other owner or holder of mortgage — -
Address of assignee(number and street,ray state,an
Drawer NO OJ .
• Does applicant own property in any other ...44.l as this deduction been requested on property .
counlylolnd'ana? ❑ Yes ❑ No I ,S� J rwrtentyear?
/L4n� ❑ Yes ❑ No
Card NO.
Deduction approved In the amount of'.
199, 9c0. °°
20 20 20 20 20 I 20 20
Signature of County Auditor County Data(none,day,year)
I 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 ntract buyer of the aforementioned property on date application is filed.
o es lull name) IQ Date(month,day,Yeah
I�.
resid t ress of applicant(number and y,state,and ZIP code)
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 dry.state.end ZIP code)