HomeMy WebLinkAboutMortgage_Fidler (3) n. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
I-2-- State Form 43709(R71/6-09)
Prescribed by Department of Local Government Finance
Iiiiirli k
INSTRUCTIONS: aWppWadp
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. FJ U L D'G:2013
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. ❑ 'County Auditor
2) Mobile/Manufactured Homes not actessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought ii . "•�I"''ar
I n'1
v,.. !!.)1b.
See reverse side for additional instructions and qualifications. GIRSON COUNTY AUDITOR
Appennt(%e buys -seecTioru����9derse side)
Ta. • t n- ,� /� CJ/-/1nnummber I legal old/esai�/_ rd number Pa a nu
I /1 & 076- a2 —/Y. oa_ °Oa. //o - ooze 5,3 ./6
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of —Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,cement year date of application^ — legal or equitable owner?/9 /ccn ❑ 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 the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home QC 6-1.1-7)
-
Name of mortgagee or contract seAer'^'^N nt it
Address of mortgagee or contract sefer(number and d street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage _ n� �
dC , /2,022-/U / .4e
Address of assignee(number and street,city,state,and ZIP code)
— . .. I If yes,what county? • What Taxing District? Has this deduction been requested on properly
G-1514 �0 for anent year? ❑ yes v LNM1 ❑ No
13 Jl ml�/"r 6wc COUNTY AUDfTOR
/j
3/1 n, 20 20 20 20
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 contract buyer of the aforementioned property on date application is filed.
re(owner's ramss) �' ` Date(month,day,year)
tF150 I address of a�firan�umper aM S (lily,state,and ZIP T , `+ 4 L"/ 70 _
Person authorized by duly executed Power of Attorney or by IIC,`'Fi�1..1'--1112-0.7 70
Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .