HomeMy WebLinkAboutMortgage_Peek STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township 1 Year
•,;: FOR DEDUCTION FROM ASSESSED VALUATION
1 State Form 43709(R11/6-09)
Presrnbed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Form Ned
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. u l
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought -
See reverse side for additional instructions and qualifications. ///���
Ape/cant(• contract buyer-see rewirmns-- - .- -side) ( // ` JUN 24 2013 _
Key rwmber/legal d-.
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Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indehtedness%1.4 t WTI C oOti,T�R
Marts 1,current year March I.current year date of application legal or equi
ya000 ❑ yes 0 N
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 the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Home pC S-l.1-7)
Name of mortgagee or contract seller
is C'4 1�, - I
Address of mortgagee or contract seer(number and street,city,state,and ZIP code) -�''"•"%- �`�= ' " �"'�`=:t_..�r
i3 - 4665
Name of assignee or other owner or holder of mortgage
�� �/sj/¢a �]�e/J� Drawer NO
Address O•fU lc'-+/t ab/`_ tt state, Oi / i
Does applicant own property in any other If yes,what county? . What Taxing Del . Card NO.
county in Indiana? v� - _ 2i
❑ Yes ❑ No ��C�,�]�� � ��5 1'-7
1
COUNTY AUDITOR I\ S l4 L� L
.(
Deduction approved in the amount of: j . "^"`^' �
20 20 20 20 20 20 20
Sign erne of Canty Auditor County Date(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.
Signet rs NH name) Date(month,day.year)
0
resident add pp(xant(number and street,c* .state,and ZIP code)
x07 M. id es-e- S-e r'n.;r-c-e.r°„--- _L /--r q7 17 3
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authored person (number and street,city state,and ZIP code) .