HomeMy WebLinkAboutMortgage_Craney a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County p cy
t ' ._ rr
;; FOR DEDUCTION FROM ASSESSED VALUATION
?i'=:a !. State Form 43709(R11/6-09)
• a"`i Prescribed by Department of Local Government Finance
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INSTRUCTIONS: 11 4 I
Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during The year for which the deduction is sought. ' ,Co.my 1;d'•
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(72)months ,�L r.�a� f/-
before March 31 of each year the deduction is sought. - GIBS S N • x I • • -
See reverse side for additional instructions and qualifications.
AP 7
buyer-see - :•: verse side)
1reg P�Try�� Mja a) I //i /J a 57_,.70,_ 4 /l016/-ao 6 dl/ /J l(
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the appficant the sole
March 1,nrrent year March 1,cement year date of a ��(//,, legal or equitable owner?
/ `!Vf-�
El Yes El No
If no,what Is his/her elect 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 th property in question:Annually Assessed
Real Properly ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Al ei C •
Address of mortgagee or contract seller(number and street,city,state, ZIP code)
_ Name of assignee or other owner or holder of mortgage n / �./ , // J 07 - �1 0e/ Y fred
-----'number and street,city,state,and ZIP code) ]/"�J� <�•L�/,( C_Y`f/--CJ Y
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Q, r� it county? • What Taring District? Has this deduction been requested on property
for anent year? ❑ Yes ❑ No
/3+ 1 i�// COUNTY AUDITOR
(/IV 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•• buyer of the aforementi•red property on date appf.=tion is filed
,/ Signature(o , I •/•) /ea Ale Date(month,day,year)
Full resiladdress of app&ant( umber and street,^ e,and ZIP cod jr
1 I/3ao s. K-st b' JV'- t r-�ve Ar7Y li 76eo
Person authorized by duty executed Paver of A1:omey or by IC 6-1.1-12-0.7 / y Date(month,day,year)
Address of authorized person (number and street,d state,and ZIP code) .