HomeMy WebLinkAboutMortgage_Lamey (17) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
!'�}1I State Form 43709(R11/609)
te, Prescribed by Department of treat Government Finance
File Mark
INSTRUCTIONS: -
lbbefiledin
F. F " 1
person or by mail with the County or County Recorder of the county where the property k located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought County ditty
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file during the twelve(12)months
before March 31 of each year the deduction is sought - rder
See reverse side for additional instructions and qualifications. GIB • • • e ` - • I I • -
Appric�nt o.1n buyer- resttti•ns reverse )
Key number/legal desaipnfil as Of ITa 0ax.. '776 - ��-¢300-ODo?-/c2%c�o� -lJo?� 46 /�, Rage 7O d'
^�robe of real popery as Mortgage I Contras indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
1,wlelt year Marts 1,current year data ofappGotion�-��77��((//�p legal or equitable owner?
❑ Yes ❑ No
If no,what is his/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 property in question,Annually Assessed
Real Property ❑AnnuallyAssessed
Mobile Home QC 6-l,1-7)
Name of mortgagee or contract seller /'4/��LC / yep / it
Address of mortgagee or contract seller(number and 4�, ee/t,cE y,state,and ZIP code) "///1(j^/K--.(�/
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Dees applicant own property in any other If yes,what county? - What Taxing District? Has this deduction been requested on properly
county in Indiana? I - for current year?
❑ Yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR .
Deduction approved in the amount at
20 20 20 20 20 20 20
Signature of County Auditor County 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 contact buyer of the aforementioned property on d i application is filed.
�9 (a_Oda- � - QLC/L-ea CL �.�! V //l� Date(month, , year)
Y
Full resident address of applicant(num r and street, te, code)
//i-..5 if S /JO 1, �„�,tio ,,Q6,. �7i�9
Person authorized by duly executed Power of Money or by 1 61.1-12-0.7 Data(month,day,year) _
Address of authorized person (number and street city,state,and ZIP code) _ .