HomeMy WebLinkAboutMortgage_Henning i" STATEMENT OF MORTGAGE OR CONTRACT INDEBWt�E I Township Year I
6 '<s:: FOR DEDUCTION FROM ASSESSED VALUATION gg �r
State Form 43709(R11/6-09) -
Pr scdbed by Department of Lod Government Finance
JUL 19 2013 File Mark
INSTRUCTIONS:
with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where th i •ropprtyj'i.In.*, Form Ned
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought I, , I!A11.r 0 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must hl , -
before March 31 of each year the deduction is sought Li C ��t rI• t �.0 U ITO R County Recorder
See reverse side for additional instructions and qualifications.
Ap rant(owner or tract buweerictRns on'averse side)
aAsz n in.tai
TaOrT D/is�tr�ic�t: Key number/legal description 33/] Record number Page number
Assessed value of real 22 ^1 property es of —/9 e C«rtr' indebtedness tropeO`/ Mortgage Contract rr 2.Oa/ '-3 3hi9
Abrtga� Is thhe appdrant the sole
March 1,arrant year =gem/
,cu[rr��entt ylear date of application - legal or equitable owner?
2_Q Q 71. 9 ❑ 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 afferent than that of applicant,Indicate below: 6941 the property in question:Annually Assessed
.�.--�- Fnoerty ❑Annually Assessed
ITC 61.1-7)
Name of mortgagee or co,saber Z/// Drawer �(�/
Address of mortgagee seaer(number an street,city,state,and 21 1.. - : Drawer 1NO, & / 3
Name of assignee or other owner or holder of mortgage 310 /
. Card )\O.
^///111 /�.... /� t
Address of assignee(number and street,thy,state,and ZIP code) .., _/9 9 1 J (1:a•I I''
Does applicant own property in any other If yes,what county? • What Taxing District? U Has this deduction rrr���been--r11.:y...___ erty
county in Indiana? ID Yes ❑ No for current year?
❑ Yes 0 No
pp�� t'5L 5—/Q COUNTY AUDITOR f:-' c' y
u aon
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.
�SSii/gnaaue(o • hA name) ///�/�i Date(month,day,year)
Si resident address of = (b Aber ardreeC ,state. P code)
PPP\\\/// 407 F /6OD Ll{ Fa%7- fl,/4/ 't 71 Itg
auttoraed by duly executed Power Of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,rib/:state,and ZIP code) .