HomeMy WebLinkAboutMortgage_Mitchell . STATEMENT OF MORTGAGE OR CONTRACT IN ES Dnty Township Year
FOR DEDUCTION FROM ASSESSED VALUATIO � ��{�� ```�(
t. State Form 43709(R11/6-09) V
Prescribed by Department of Loral Government Finance 2013
S7RUC77ONS:
AUG 5 File Mark -
be filed in perm or by marl with the County Auditor or Court Recorder of the coup whe•- the Form Ned with:
Filing Dates: 1) Real Property Must file during the b county pica.-nh it
ng year for which the deduction is sought. ' fll lino County Auditor•
•2)Mobile/Manufactured Homes not assessed as Real Property Must file du , • rdt�
before March31 of each year the deduction is sought GIBSON COON - �'fVR County Recorder
See reverse side for adder al instructions and qualifications. •
Key number ..•. desaip/• Record ge number
.-fe 94,-/4-,A-303- 000. 72-Odco 7 Pa3//d"
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the epp1rant the sale
Marts 1,anent year Ma 1.017 ygq „ 0 O 0 date of apW�ation legal O We
/ hIJ�O_�l Yes 0 No
If no,what is his I 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:Annuafy Assessed
❑Real Property ❑Annually Assessed
• Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller ittr 090_1(J�///��
Address of mortgagee or contract seller(number and street city,sta:,and ZIP code) U U
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? - What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
- ❑ Yes ❑ No ❑ Yes ❑ No
® Drawer \O•.. _ _- COUNTY AUDITOR --_
Card \'O. . / / Q . zo zo zo zo
E h rJ IL County Date(month,day,year)
I/We certify under the penalty of perjury that the auuvo......foregoing information is true and correct and that the applicant is a resident of Indiana and
owner/s•••-d buyer of the aforementioned property on date application is filed.
'. .,/ . //'i Date(month,day,year)
li•Flit fir.• _-of appli ant �slieet city,state,and code), K
Person authorized by duly executed Power of Mornay or by IC 6-1.1-12-0.7 r Date(mod?.,day,year)
Address of authorized person (number and street city,state,and ZIP code) ,