HomeMy WebLinkAboutMortgage_Lintzenich STATEMENT OF )F MORTGAGE ES OR CONTRACT INDEBTEDNESS Count 11 Y J Township Year
Gipio,r`'��; FOR DEDUCTION FROM ASSESSED VALUATION f 1 -
State Form 43709 Department of Local Government Finance
File Mark
INSTRUCTIONS: M
A
•7o be filed in person or by mad with the County Auditor or County Recorder of the county where the properly is located. IYI �tai
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 Property Must file during the twelve(12)months I , �,�
before March 31 of each year the deduction is sought - -€!mil; my Recorder
See reverse side for additional instructions and qualifications. GIBSON a . • - , oil •R
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Applicant(owner or contract buyer-see re - %4, on fevers°side)
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zingDisbict Key number/legal d-= l• Record number Page number
a-& -- / 2 -ol - 4/oy- ovv .3o5e -orz 70 g. 0 in ?
Assessed vakte of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1.current year date of application legal or equitable owner?
If n o,what a W his/her exact share of interest? If owned with someone other n cpu I cu•ce,indicate 7 ❑ Yes ❑ No
with whom
If name on record is different than that of applicant.indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home QC 6-1.1-7)
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Name of mortgagee or contract setter 5.,73
Address of mortgagee or contract seller(t mber and street,city,state,and ZIP code)
_ / - - — —
_ —
Name of a
Address o
Does app? 7 s deduction been requested on property .
county in I /C3:\@\ ��"� eft yeaR ❑ Yes ❑ No Deductron
20_ /\ 20 20 CSOCN
Signature /:g / \ Data(month,day,year)
V. r •.I V -L-J'
If We. applicant is a resident of Indiana and
owner
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1 Synab�uy
Date(month,day,year)
'`\ Full reside __.._
070 117. Se(c1A sr. Ovum,- .`t le iv ")(„ 6 S
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,arid ZIP code)