HomeMy WebLinkAboutMortgage_Burke STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County JrThJ iit Lr
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09) Fin
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: . _ i !
Forth 1ed-s .
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. • •n •
2) Mobile/Manufactured Homes not assessed as Real Properly Must Me during the twelve(12)months ,-i b i'd
before March 31 of each year the deduction is sought �`°fi is '•• '�
GIBS} i • • • _ . a .
See reverse side for additional instructions and qualifications.
Appfirant(ov •(or contact b -see on reverse side) d
W t 19-e-F' ton . U �l 011-co 31 CF)„ 1 Record number Page number
T . District J
-"PIE 11 2 � 01(0 In-a — g1:::0Thi — oaa_ ( lq —h X013 An801.
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Month 1.anent year March 1,current year data of application legal or equitable owner?
k DV)Ctz) Wes El 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: 15 the property in question:Annually Assessed
r����`°^''Property ❑Annually Assessed
....--14obtle Home(IC 6-1.1-7)
( mortgagee or contract seller \
Address of mortgagee or contract seller(number and street,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage / / O
th •
Address of assignee(number and street city,slate,and ZIP code) -— / \O•• "/�I o�•..•
�`;C' 1 I•
Does applicant own property other If yes,what county? • �,r - .•• r(1 ..requested an property•
county in Indiana? O UV
o El
COUNTY AU&
Deduction approved in the amount of: .
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,sear)
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 data application is filed.
Signature(. Jy's name) , , — Date(month,day,year)
FW "dent of ap' -. t •n and street alt:state,and ZIP code)
11/x_7 r�•.C3SL Sov,t-�•, "—(So CAS*
Irsonh
authorized by duly executed Power of Attorney or by IC 6-1.1-12-03 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .