HomeMy WebLinkAboutMortgage_Moore (7) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
;; FOR DEDUCTION FROM ASSESSED VALUATION }t
_2' ' State Form 43709(R11/6-09) F I
Prescribed by Department of Lod Government FFance
e a
INSTRUCTIONS: c tt�U e ltYn
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located. SE1 Lu13
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/Manufactured Homes not a«rsed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - .)�(( er
See reverse side for additional instructions and qualifications. 01 BSO N COUNTY AUDITOR
Apr r or contract buyer-see restrictions on reverse side)
Ta Key y,Jra number/legal description Record number Page number
a-i 3 for-05 - 94 -107- 003. B9Si- Od7 20 /3 YS7 `�Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Math 1,arrant year March 1,current year date of aPPGCai legal or equitable Amer?
SYD00 ❑ 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 appfran4 indicate below Is the property in question:Annually Assessed
❑Real Property"❑AnnuallyAssessed
• Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller .51/2 -- _- -----
Address of mortgagee or contract seller(number and street city,state,and ZIP code)/ (/'�'
Name of assignee or other wmerotlaMUotmortgage
Drawet_ NO.. /� ,[ I -
Address of assignee(number and street,city,state,and ZIP code) Card NO.
Does applicant own property in any other If yes,what county? • What Taxing C
county In Indbna? ❑ Yes ❑ No .•
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of, County Auditor County Date(month,day,year)
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.
X gAJ,4-�- 10,} Date(month,/fin „20/3
II revdent address of a Grant(number and sbaet,dry,state,and ZIP e)
AG175/ N• a. ,O GS ato4c0 Sit V7b/a/
Person authored by duty executed Power of Attorney or by IC 6-1.1-12-03 Date(month,day,year)
Address of authorized person (number and street,dry.state,and ZIP code) .