HomeMy WebLinkAboutMortgage_Rothrock J SFTOAR T EDEMDEUNCT T OIOF N M FORROTM A AGSE S EOS CEOD N AUCAT T IINODN E
BTEDNESS County Township Year
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State Form 43709(R11/6-09) fi J ,E,
Prescribed by Department of Lad Government Fiance
INSTRUCTIONS: ei 1q
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. MA • ,. tU I J
Filing Dates: 1) Real Property Must Me during the year for which the deduction is sought. 7'1 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)months
before March 31 of each year the deduction is sought - I. • • 1.7.- • -emrder
See reverse side for additional instructions and qualifications. BIB SON COUNTY AUDITOR
Apptcant(owner or contract buyer-see reverse side)
3Qrr \ era othroo I.
Ta vi3OL District Key number/legal descriptcm Record number Page number
et0h I awn—LO -0 � — I00-00' -9 \c —GYM /3 • aJ
Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the app6cant the sole
March 1,current year March 1,anent yfarr date of application legal or e owner?
If no,what is his/her exact share of interest? 5 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:Annually Assessed
:Real Property ❑Annually Assessed
Name of mortgagee o contract sect��'1o1 /� T
l�er' rnan !7 m ar1c-ct rl-,
Address of mortgagee or contact seller(number and street,city.state,and ZIP code)
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Name of assignee or other owner or holder of mortgage /1 _ n/I �A/// �,I
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Address of assignee(number and street,city,state,and ZIP cede)
3 55
Does applicant own property in any other Ili yes,what county? - What Taxing D'afi 13 - /
county in Indiana? I (//(,
❑ Yes ❑ NO
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COUNTY AUDITOR I CS
Deduction approved in the amount of fy � t ` /V
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20 20 20 20 20 Gag!'�` ' �� coP
Signature of County Auditor County �t"' l�
I/We certify under the penalty of perjury that the above and foregoing information is true and cl
owner I contract buyer of the aforementioned property on date application is filed.
Sig . _ - • -es full name)
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♦Cus -..e -•dress of applant(number and sbee4 ul):slate,and ZIP wile)
b /, 7iC" €, �.,� � S• l � a- �7 ��
Person authorized by drily awaited Power of Attorney or by IC rr .1-12-0.7 4Date(month,day,year
Address of authorized person (number and street rely,state,and ZIP code)
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