HomeMy WebLinkAboutMortgage_Friedman (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
1'. State Form 43709(R11/6-09)
Presaibed by Department of Local Government Finance
File Mark
INSTRUCTIONS: F
To be filed in person or by marl with the County Auditor or County Recorder of the county where the property is boat
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. aid• Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12) s
before March 31 of each year the deduction is sought - County Recorder
See reverse side for additional instructions and qualifications. ,1 p ,of
APPlicant(owner or con buyer-see - on re site) / 1Y,�� L _ 02/� �
7 r�]{(-/°"_'NY'e>,�`��f�L . 740. 'A C/‘_r:: .. /
Tt iswx raj Key num,- IegalV lion .f mmIr -age marker
0174,-1, —.15-, cv3 ,_39a 6Q WI P1
Assessed cobra of real Mortgage/Contract indebtedness paid as of Mortgage I Contract rode. .. '---
ss ••-.•as of Is the appficaM the sole
Marct11,arrart year March 1,cement year date of application legal or equitable owner?
/ / , 76)d ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with wham
If name on record is afferent than that of applicant indicate below- Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
. Mobde Home(IC 6-1.1-7)
Name of mortgagee or contract seller (5/
vJ
Address of mortgagee or contract seller(number and street,relt wm.a 710 rnw.v.
Name of assignee or other owner or holder of mortgage Lc i
Address of assignee(number and street,city,state,and ZIP (.fir r�/�
Dues applicant own property in any other I If ye: j { ' x7 Has this deduction been requested on property
county in Indiana? fi- 0 for anent year?
❑ No
❑ Yes
❑ Yes -� (V x ❑ No
Deduction approved in the amount of
20 20 20 20 20_ 20 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 correct and that the applicant is a resident of Indiana and
owner/.••..ct buyer of the aforementioned property on date application is filed.
slid -, re/(.J/[�/,ie fuuti,p Date(month,day,year)
-Fu :-49' add f a t(number and street city,state,and ZIP code)
P=-•authuria.d 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,city,state,and ZIP code) •