HomeMy WebLinkAboutMortgage_Moore (16) N L County Township Year
.,„„. STATEMENT OF MORTGAGE OR rF ;` FOR DEDUCTION FROM ASSESSED T N y V
State Form 43709(R11/6-09)
prescnbed by Department of Local Government Finance
AUG 2 2013 File Mark
OSTRUCTIONS: Form Aed with:
be filed in person or by mail with the County Auditor or County Recorder of a county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the dedu n is•so ht. gg--thUnty Auditor
2) Mobile/Manufactured Homes not assessed as Real Prop the twelve(12)months
before March 31 of each year the deduction is sore SON COUNTY AUDITOR ❑ County Recorder
See reverse side for additio tat instructions and qualification
\„WApplicant(owner or.. ..Air-see e)/legal Distrct Key `/-•C%(v-I -I0I-003 -3G(--oaf arc pars
it Assessed value of real popery as of Mortgage cu/Contract irdebtedn u id as of Mortgage f Contact indebtedness unpaid as of Is the appliant the sole
March 1,current year March 1,a/mt yeea r� . .
data of emigration legal or equitatle ow'neY.
/WTI 17114 ❑ 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
0 Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract suet(number and street,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
-----•--=.W ZIP code)
in
Ct .€ / V r7 S hunty? - What Taxing District? Has this deduction been requested on properly
J�J� for current year? ❑ yes ❑ No
® /3 -.3/95 COUNTY AUDITOR
`2p I ,v I 20 20 20 20
Signature of ty' 'tor County Data(month,day.year)>Atli t
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.
Sig o er's MI name) Date(month,day,year)
0 -2 c6/3
1.Fug resident address approant(number and street,city,state,and code)
>°3,9 y U/es-f" P,nzsf a,klte`on =tit 97(o76
Person authorized by duly executed Power of Attorney or by IC 6.1.1-12-0.7 Date(month,bey.year)
Address of authored person (number and street city,state,end ZIP rode) .