HomeMy WebLinkAboutMortgage_Sauer STATEMENT OF MORTGAGE OR CONTRACT IND SS'�1 Township Year
f I H j
'�l FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Loral Government Finance
JUN 10 2013 Rile Mark
INSTRUCTIONS: Form filed wddr:
To be filed in person or by mail with the County Auditor or County Recorder of the county wh- e pro•-rty' ocat"• �p
Ring Dates: 1) Real Properly Must file during the year for which the deduction is sought ` el V I County Auditor
2) Mobile/Manufactured Homes not as^ ssed as Real Property Must 7,= •_'Miser �1- months
before March 31 of each year the deduction is sought T A DITOR ❑ County Recorder
See reverse side for additional sins nand qualifications. r� ,, ,,n /1
MPfxan)'(ownar or. •6 i IgJO[0 �aCI_!/�-/
axing '•isthct umber/legal description Record number P e number
07&,—i8-0lo-tiO3 coo -v44L co ? crab 5 �9 27
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,astern year March date of application legal or equitable owner?
o
❑ Yes ❑ No
If no,what is his I 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: Is the property in question:Annually Ofreal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 5/
Address of mortgagee or centred seller(number and street ray,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Dces applicant own property in any other If yes,what county? • --•eauested on property .
county in Indiana? Dr Yes ❑ No Dl a)vet-No asn �❑ No -
COUNT • •• V 5
Deaumaru approved in the amount of: Card l�'0• •Q
20 20 20 20 _ C/ •.7. ,_
•
Signature of County Auditor County I Date _
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.
ditty(owner norm�/ Date(month,day,}year)
•
Full ent address of app(Ican number and street state, calla) /I 5
V i /r 5 5 v<m �y , 3'n3
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sneer,city,stare,and ZIP code) .