HomeMy WebLinkAboutMortgage_Blackard ? STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
s l: State Form 43709(Rment of) IL D
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Prescribed by Department o(thcal Government Finance
INSTRUCTIONS:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the m F
N h ty property is located. 9r.� ((�1'1 a�
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought CounYSlBimr
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 ///� .Co. ^b T"r1NA.l
See reverse side for additional instructions and qualifications. GIBSON r•
appbrant(Jn (oo»�m or con tact beyer�m . . on raverspyde) 4 OUNTY AUDITOR teaie 0�o r✓M-'-C. 'Key number/legal description Record number Page number
x6 .19- o5' - 306 - oo1. / 6b - 0L-.S 8,o / 3 38 .23
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sale
Mardi 1,current year March 1, date of application legal or equitable owner?
j� 000 0 Yes 0 No
If no,what Is his/her exact share of interest? ' If owned with someone other than space,indicate with whom
If name on record is different than that of applicant,indicate below. Is the property in question:Annuafy Assessed
❑Real Property ❑Annually Assessed
Mobile Home QC 61.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and t city,slate,and ZIP code)
Name of assignee or other owner or holder of mortgage
Add of assignee(number and street,city,state,and ZIP code) _
)r NE 9 -3 ^/o . c, o Ac_.
Does applicant own property in any other If yes,what county? • What Taxiry
county in Indiana? ❑ Yes
❑ No � 1
COUNTY AUDITOR '5 S 1 y 3
Deduction approved in the amount of 0 t 3 -
20 20 20 20
•
Sig re of County Auditor 4 County — —
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 aid
owner/contract buyer of the aforementioned on date application is filed.
Sonatas(owtoCs full name) / / Data(month,day,year)
1)(11.44.4 / 1120.(
co resident address of appe ant(number and street city,state,and ZIP code)
1941 “ 6coo s rr Q fle- Tilt y76,XS
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,state,and ZIP code)