HomeMy WebLinkAboutMortgage_Walden ^;•,, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count I Township Year
-_ FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RFI/6-09)
"' Prescribed by Department of Local Government Finance g _
®„ � File Mark
INSTRUCTIONS: I JL : 1,.'
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which O dedd ction is sought.
Must be tiled with the County Auditor or County Recorder of the county whe r®rt2GfScated ❑ County Auditor
on or before January 5 of the immediately succeeding calendar year. 1J ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with 1 e County Auditor of the
county where the property is located during the twelve(1 2)months before h 39 of ac
deduction is sought. GIBSON
See reverse side for additional instructions and qualifications. COUNTY AUDITOR
I A"pli/cant/o/wn�er or contract buyer-see rr frtiionnss on reverse side)
¢ ( 1 .lull t.l Li( l�lA v 1 �Il`i rE�!Ift:
orDistrict / Key number des ptan /r OW-jog Record number I p,41/ ra!,i02836
1`nsv i 1 i c 0-11-l& 611 — U % "tTJ JtP](J
Assessed value of real property as of I Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year I March 1,current y date of application legal ore tillable owner?
/�(p1 i @8. CO or ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
N9�mff of mortgagee or contract seller_ ff // • •
nail m n n /P .�� C) ty R 1 �
Uty L L e1
Ives;of mortgagee contract seller(number and street,city. te,and ZI I a ) C ICLA-M ir--Q r 4 (A �-�o \and Lko (So)s
Name of assignee or other owner or holder of mortgage G )
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑
Yes I No ❑ Yes ❑ No
IA` COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County I 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 I contract buyer of the afo mentioned property on date application is filed. tJh /y�
Signature t/ / =)' 4/` Date mph/ /an
F u - I address of applicant(number an street.city,state,a ZIP cod l
1�Th-Fh clh i rrl �l��l 51 IC P l
Person authorized by duty executed Power of Attorney or by IC 6-1.1-1 0.7 r Date(month,day,year)
Address of authorized person (number and street.city,state,and ZIP code)