HomeMy WebLinkAboutMortgage_Folsom (2) STATEMENT OF MORTGAGE OR CONTRAG�f INTE1TF S ) County • Township Year
FOR DEDUCTION FROM ASSESSED VAL I N
t-.t State Form 43709(R11/6-09) JUN 1'0 2013
—' Presaibed by Department of Local Goverment Finance
File Mark
INSTRUCTIONS: �(n,J
To be filed in person or by mail with the County Auditor or County Recorder of the"'/� party is located. Porn filed with:
Filing Dates: 1) Real Property Must file during the year for which the dedyl; 10f)UNTY AUDITOR ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real P ust file owing the twelve(12)months
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications.
Ap (owner or contact see res ir'(rs verse side)
..earat/a4
T District Key number/legal description Record number Pc/member
d tsj ± aL-i 9-i8- (30ti coo 4Y0 ca.4 9O/ 3 so /0
Assessed of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the app9tant the sole
March 1,anti year Marts 1, rent b date of application legal or equitable owner
.S g' CC..CCJJ ❑ Yes ❑ No
If no,what a his I her exact share of interest? V 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
Mobie Home(IC 6-1.1-7)
Name of tee or contract seller '
en 7fl_1'',y) A-n.49_,
Address of mortgagee or contract seller(number and street city 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)
Does applicant own property in any other If yes,what county? W CO\S OPt\
010:94-0Y
county in Indiana? ❑ Yes ❑ No
COUNTY AUC 7 )li- 3 .
Deduction approved In the amount of: a
20 20 20 20 zu 20 20
I
Signae of County Auditor •
m un County Data(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.
Signature 7 I f: Date(month,day,year)
Fv Rent address of•Y..�. t(nu her tC ten and , e n r /^l I-62‘7�
_ authorized byyr'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,a and ZIP code)