HomeMy WebLinkAboutMortgage_Bailey STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS coup I towri Year 1
-,iii FOR DEDUCTION FROM ASSESSED VALUATION
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State Form 43709(R11/6-09)
- Prescribed by Department of Loral Government Finance
FR; y 013
INSTRUCTIONS: '•1 7
orm filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought u tr �,.: • ditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months ',�,:III-��!11��,.
before Marsh 31 of each year the deduction is sought - ri1 `.
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See reverse side for additional instructions and qualifications. GIBSO C• N
Appfcapt(owner or contract buyer restrictions on reversg sidae)
'zing —jy 1 �-J Key number/ desailper+ Record number Page number
3.L- tz• �S- 1D b 'hc�.53? ' CS 4 c> L3 31 (0
vaba d real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
1,anent year March 1,arrest date of appEcation legal or equitable owner?
bpD I4fes ❑ No
If no,what is Its/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: - malty Assessed
aAssessed
Home QC 6-1.1-7)
Name of mortgagee or contract weer 690)3•...
s oy_p s; s-.�. -��.P , D1a,��1. �o.....31 ......
Address of mortgagee or contract suer(r and street. state,an ZIP code)
Name of assignee or other owner or header of mortgage `O. I
Address of assignee(number and street,city,state,and ZIP code) card a-ii-.�
Does applicant own property in any other If yes,what county? - what Taring District? Has this deduction been requested on property .
county in Indiana? ttt------���,,,,,,,,, for convent yeah
❑ Yes To es ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signabae of County Auditor County Date(month,day,year)
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.
Slgratur wne/s-AN name) Q V , rs Date(month,day,year)
fl.i\?r� f /p
/president address o ppfeant(number and£4 city. tee,and ZIP codes)
■Fe na$S duty Power of or by 6-1.1-12-0.7 —b 6 Date(month,day,year)
Address of authorized person (number and steel,dry,state,end ZIP code) .