HomeMy WebLinkAboutMortgage_Dunlap STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
l! Stale Form 43709(R71/6-09) ggg
Presaibed by Department of Local Government Finance
INSTRUCTIONS: F File Mark
Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the prope ted.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is so County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must r�the in(12)months County Recorder
before March 31 of each year the deduction is sought ty
See reverse side for additional instructions an.qualifications.
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Applicant(owner. -., •r M III;
a� • V I'in lAd f/. • �t st. tea,: 'LF A A // '
Ta nurr}grr e9al deKn 8_y t Record number :..e numher
c C �L ,Xf , - /(/Y D�L�O� a�i Oc1l�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year Mardi 1,ourent date of application legal or equitable ownrll
J' 3900 ❑ 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 the property in question:Annual&Assessed
❑Real Property ❑Annually Assessed 1.1-7)
Name of mortgagee or contract seller ' / / / _^ /
Address of mortgagee or contract se ler(number a street city s-fs state,,/amend 21 coda) 11 T�
Name of assignee or other owner or holder of mortgage UUU
Address of assignee(number and street ray,state,and ZIP code)
91.4 ii CPa3r aunty? What Taring District? Has the deduction been requested on prrzwrty
,,.00.,,��//C 'P for current year? ❑ Yes ❑ No
Drawer NO, y I COUNTY AUDITOR - (-
Card NO. , . .t + ,�
53,5m;°52- .°� -, : - 20 20 20 ( 20
1
Sigma.. qtr County Date(month,day,year)
4 / L 1419 114 k_
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!contract buyer of the aforementioned property on date application is filed.
.re owne/s lull name) Date(month,day,year)
' •' JJ �Pn J���
Fug -' 4.of a`jF+ tat(( tier and ZIP code
0 6°Person authorized by duty executed Power of Atromey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street ray,star,and ZIP code)