HomeMy WebLinkAboutMortgage_Sermersheim (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
time,;; FOR DEDUCTION FROM ASSESSED VALUATION
If State Form 43709(R11/6-09)
l Presmbed by Departmental Laval Government Finance IF I
INSTRUCTIONS:
To be filed in person or mail with the County Auditor or County Recorder of the county where the Form fled
Pe by ry ic ty properly is located. AU(� r7
Filing Dates: 7) Real Property:Must file during the year for which the deduction is sought �f digu
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 - i1, ❑ Coun Recorder
See reverse side for additional instructions and qualifications.
Appl t(owner arrontrad17-sea rash 'ns on reverse sire)
CIBSON COUNTY AUDITOR
ofacol d � x
-
T79 Disttd Attna4....„ Key number/legal description Record number Page number
;lo — ia - o7 - koa - ooe. j - 0a8 1 ,3 d. ..1. ( 7
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Con'aact indebtedness unpaid as of Is the app6rant the sole
March 1,current year Mardi 1.arrtent year date of appr�tzn legal or equitable owneR
II o O0 0 — --- _ ❑ yes ❑ No _
If no,what Is his/her exact share of interest? / if owned with someone
If name on record is dfferent than that of applicant Indicate belovr. 2 GE 7rt. O
. ES �� - /Cfj(
Name of mortgagee or contract seller V e—id A� /1
Address of mortgagee or contract seller(number and street city state,and ZIP code)`(//� �� ��
.--Mi
Name of assignee or other owner or holder of mortgage J
Address f assignee(number and street city state,and ZIP code)
• IT SE ? - 2. - /o . te09- 4 /, �y (,o
es
Do applicant own properly in any other If yes.what county? • What Tardng District? w V' w V
county in Indiana?
❑ Yes ❑ No
COUNTY AUDITOR 0(j) Nr, / `l ,
Deduraon approved in the amount of: (-! P /4
20 20 20 _ 20 20_ 7
Sigma of County Auditor // County /3 22/
I/We certify under the penalty off perjury that the above and foregoing information is true and a
owner I contact buyer of the aforementioned property on date application is filed.
n
Sigahue(owner's hS name)
k .rte -R �
1/'Full resident address of apprcant(n bet and street aTy,state,and ZIP coda)
Person authorized by truly executed Power of Attorney or by IC 6-1.1-12-0.7 Oh
)
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Address of authorized person (number and sweet dry,state,and ZIP code)