HomeMy WebLinkAboutMortgage_Nurrenbern M ., . STATEMENT OF MORTGAGE OR CONTRAC Q! ItE ED S County Township I Year
W.-; FOR DEDUCTION FROM ASSESSED VALUAA�g10 JJ 1 Its �,A
State Form 43709(R11/6-09)
Prescribed by Department of Lod Government Finance AUG 2 2013 File Marx
it STRUCTIONS: Form flea :
be filed in person or by mail with the County Auditor or County Recorder of the cost t where c- .'- •is located.
Filing Dates: 1) Real Property Must file dining the year for which the deduction is •..,: -ion rip, ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Prope y f3 y-65iparyvtAtierrtyRnths
before March 31 of each year the deduction is sought. ❑ County Recorder
See reverse side for additional instructions and qualifications. /�
Applicant(owner or cantrac yen-see 'lions on reverse si�7llr� a WAI n M` ^ ' _
•Ism, Key rwm I al des e'p' Record n Page number
a�..4�/ d�a. 7 - o2G0— co/. 886-da`� s/
• J .value of real property as of Mortgage/Con • ebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appr:ant the sole
\;r 1,aarent year March 1,wrten date of app�bon legal or equitable owne?
3 s ow ❑ Yes ❑ No
If no,what is his/her exact share of interest? / If owned with someone other than spouse,indicate with wham
It name on record is different than that of applicant,indicate below-. Is the property in question:Annually Assessed
❑Real Property ❑wally As ( 6-1.1-7)
Name of mortgagee or contract seller f j
Address of mortgagee or contract suer(number end street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address r•___L___-•--`__-.n.sw-/w-emm.and 7m mAet [p
Does ON /�1 / Ek�(J 01406 ie What Taxing District? Has this deduction been requested on property
courtly in I v l e � � tot current year? ❑ Yes ❑ No
f _ RUNTY AUDITOR
Dedurac / 2 j 5 I4
20 `/7 20 20 20 20
Signature or County Date(nnnmay,jar)j5
I I We certify er the penally 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.
,tsa nann�� c Date(nmtlt,day,year)
ua resident of applicant(number and_street,oily;state,and ZIP code)
c2o • E Ars/oi -ar' /�a.-ss/ctr 4'? 2f
Person authorized by duly executed Poykr of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet,city,state,and ZIP code)