HomeMy WebLinkAboutMortgage_Hurt E.'f'� STATEMENT OF MORTGAGE OR CONTRACT INDEBBDIiE Bo my Township Year
_si.a'• FOR DEDUCTION FROM ASSESSED VALUATION
:.,' !=4r4 State Form 43709(R11/6-09)
'
� et Prescribed by Department of Local Government Finance JUL 1 2013 File Mark
INSTRUCTIONS: n/�, _
To be filed in person or by mail with the County Auditor or County Recorder of the county wherE/tpE N�' te9— F filed
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sgwgp(�r�"NN''4�,11, 0j County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must R)A9urxrg�ne aiiWn2)
RI9 1511
before March 31 of each year the deduction is sought. R ❑ County Recorder
See reverse side for additio instructions and quay -tions.
Applicant(owner or �� - - -side)
n stri Key ... /legal d p Record number Page numbe
Assessed value of real as of Mortgage/Cq et indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as or Is the appil ant the sole
March I,current year March I, date of application Sgal or equitable owner?
Vim\" r`�`AGO (03 /09_ 7a ❑ yes ❑ No
If no,what is his/her exact share of interest? ' / tf 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
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller 0 C/12._
,
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? - . cPt
county in Indiana? 1i l• 1\O........�•••••••••• ested on property
❑ Yes ❑ No Drawer Yes ❑ No
CC
Deduction approved in the amount of: Card NO. ••�•}•
20 20 (g�— 20 2 .0 3r / /, �/Y' 20
Signs. -of I ry• •i•r A _ Date(month,day,l 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 contract buyer of the aforementioned property on date application is filed.
$Ignature(owners hill name) 1 ' Date(month,day,year)
fl;resident address of applicant(number a street,sly,state,and V ZIP code)
/IC_ `1.i s S. w w a rt C 11tikC H Rte R tvc rt)- ) fl3 41 bZ o
Person authorized by duty 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:dare,and ZIP code)