HomeMy WebLinkAboutMortgage_Martin (8) �%a- . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township I Year
FOR DEDUCTION FROM ASSESSED VALUATION
t' State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance _i_i_...E .
File Mark
INSTRUCTIONS: ;,
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. pr.013
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought 0 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
I, M_! _...er
before March 37 of each year the deduction is sought GIBS e�.�IaI
See reverse side for additional instructions and qualifications. ON -
AUD7rpR
Appfoan owner or contract -see restrictions on reverse side) c.p
4 1. 4 Loa LT �_ 2 -•t r.�eSl..-? 4,
Tj' g strict
y number/legal desoiption Record number Page number
9' m , r� ln ' l �- lS lD 1 - �7�, bn� ^ -] 31$6
Assessed value of real property as of Mortgage/Contractt indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1 wren n year March i,current 9 year a� date of application legal or equitable owner?
No
If no,what is h'is!her exact share of interest? If owned with someone other than spouse.indicate with whom \
If name on record's 6Rerent than that of applicant indicate below: I on:in questi Annually Assessed
I Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
of mortgagee or contract(seller
(
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Address of mortgagee or contract seller(number and street tdy,state.and ZIP code)
Name of assignee or other owner or holder of mortgage — - — - - - ___ ____-
Address of assignee(number and street,city,state,and: 7 1( 3
. Drawer NO .
Does applicant own property in any other II :this deduction been requested on property
county in Indiana? ❑ Yes0
Card NO. ..31 j > -
.5.4P....... eyear' Yes ❑ No
Deduction approved in the amount of
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!contract buyer of the aforementioned property on date application is filed.
Slg (owners MI name)r Date(month,day,year)
`{q� ant address offal tt((n_lu)n beetr/aY d sheet,a1)t slate,and LP code)
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Person authomed by duly executed Power of Attorney orby IC 6.1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .