HomeMy WebLinkAboutMortgage_Eley jC", FOR OF MORTGAGE OR
FROM ASSESSED CONTRACT IND TF County I Township I Year
C i'/ State Form 43709(R11/6-09) Y P
\ / Prescribed by Department of Local Government Finance ��JJ
INSTRUCTIONS: 2013 File Mark
S E P J 0
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the de•uction. sought.
Must be filed with the County Auditor or County Recorder of the ty sate‘5 54,0 ••erty is located ❑ County Auditor
on or before January 5 of the immediately succeeding calendar•• - , gm1114 ❑ County Recorder
2) Mobile/Manufactured Homes not assessed as Real Pr�nepya• , Fyyf+(,!++ycN ro/the
county where the is located during the twelve N2 'rT den rdrW arch.3 of each year the
deduction is sought.
See reverse side for additional instructions and qualifications.
App;+cai( tmer or contract buyer-see restrictions on reverse .- )
W D. [ - .�- �4CJu1c nil. EL / 3 4895
Taxing Dis IIK�ey nu r/legal description Record number Page number
.0- Ch b�6-1ga13- 403-u�.0(03-Ox/ Ptwcs4 'laSe �h 13 -'3 -1
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage!Contract indebtedness unpaid as of Is the applicant the sole
March 1.cone.nt.year March 1,current year date of a It legal or eqw owner?
1O '76 / OOO Yes ❑ No
It no.what is his,her exact share of interest? If owned with someone der than spouse,indicate with whom
If name on record is different than that of applicant.indicate below Is th property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Narn . gee or contra t se'I r4a „ rt Or Co .
Address J )01 aq gee (.�con act seDer(number sf eef.city ZlP code) , , b+I Les i
Name of assigneeteoro`_Io'ther c er or of mortgage rLl/�r.��lAs�-Kid/-f•
Address of assignee(number and street.ary,stale,and ZIP code)
Does applicant own property in any other y It yes,what county? .What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
ID Yes No ❑ Yes ❑ No
COUNTY AUDITOR I
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month.day,year)
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!contract buyer of the aforementioned property on date application is filed. — /
�ivoelure(ow .ull np) >/( a_4_/`...�:+ i e Date(rr t5s, /r) w
it esid¢m a0 es of app t�.ant Cer and sfr eft cifytre.and ZJF'aotle n ��
''PeeN^rson authorized by duty executed Power of Attorney or by IC 6-1.1.J11.2-0.77 I/��s'� Date(month.day,year)
Address of outwitted person (number and street,city state,and ZIP code)