HomeMy WebLinkAboutMortgage_Meuser (2) �fa STATEMENT OF MORTGAGE OR CONTRACT INDE Township Year
. FOR DEDUCTION FROM ASSESSED VALUATION• State Form 43109(R71/609) , Rsi,
Presa ibed by Department of 1 Goverment Fina tce
JUN 6 P013 File Mark
INSTRUCTIONS:
Form Ned with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where r- grope is 1. .tail.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. 1 ' _A rl/ only Auditor
2) Mobile/Manufactured Homes not ac..•ssed as Real Property Must me u . - nNr7.�Er•nths
before March 31 of each year the deduction is sought • GIBS9 COUNTY AUDITOR ❑ County Recorder
See reverse side for additional instructions and flirtations. •
APPacant(owner or contact buyer-see aside) ! /214(10-A__.
Record number Page 4S2c? 9ío Key /e /r con -004 9�b-f 7
00.13D as o/
Assessed value of real peaty as of Mortgage/ indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the apprrrant the sole
March 1,current year Math date of apPGcation legal a erpliable awrteR
❑ Yes ❑ No
If no,what is his/her exact share of Interest? J 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
Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller
ZIP code)
do/3 .
Na
Drawer No...n/.....
Ado r, CJC a o I .......
Does Card N O• •••••••••••••I.• What Taxing District? Has this deduction been requested m property
awrr. q o - for cement year?r I ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of ry County m'r J\�S r� ) �/ Caun `/C Date(month,day,)ear)
Ai /
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
Amer/contract buyer of the aforementioned property on date application is filed.
year)
Date(ma
Sigrtature o, hell e) (month,day,!t/� tom . 1 /11_, -4-"S-
F resident address of app4ant(number and street,city,sate,and ZIP code) •
/,(ISC �i h o ��a)/ I-"I code)
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-03 Date(month,day,year)
Address of authorized person (number and same;rdy,sate,and ZIP code) .