HomeMy WebLinkAboutMortgage_Cromer STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Year
A:__ ��
•=use,;; FOR DEDUCTION FROM ASSESSED VALUATION
n'�{t'i State frorm 43709(R71/GUg)
i@-� Prescribed by Department of Local Government Finance C Igy�
INSTRUCTIONS: SEP Y 3
b be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located. Form coed with:
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought , . IN 11 . • ditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months �,10i;
before March 31 of each year the deduction is sought. - G I BSO N C O U try ••i UITO Fi er
See reverse side for additional instructions and qualifications.
Apperann owner or tarmac/buyer- test irbwu an reverse side) \/
7 43 istrici— Key number/lega(?-- description Record number Page number
AO/410,1 / Rl,--2n -i3- 300 000 Y97-00 / don _ a3y/
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appfmant the sole
March 1,wren year Mardi 1 current year date of application legal or equitable owner?
a C 0C) ❑ Yes ❑ 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 hi question:Annually Assessed
Real Property ❑AnnuallyyAssesSed
Motile Hone(ICS-1.1-7)
Name of mortgagee or con ct seller e
0.7 rill LL/�Lr •
Address of mortgagee or contract seller(number and street,city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage .
Address of assignee(number end street,city slate,and ZIP code)
Does applicant own property in any other If yes,what county? . w,— �\J//� 2) 'erty
count m Indiana? . 1.....I•..
El Yes El No (may! `!
Drawer ��• No
COUNTY AU!
Deduction approved in the amount at �1 O. .' ........
Card N
20 20 20 20 _
I
Signature of County Auditor County Date(month,day,year)
I/We certify under 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.
Signature owners NO name) Date(month,day.year)
Fns. 0
Full n of applicant(number and snee�(,� te,and ZIP code)
-,-/o7417i 7o05 OAKLHPD C;T / lz) 47.1'O
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0 Date(month,day,year)
Address of authorized person (number and street city state,and ZIP code) .