HomeMy WebLinkAboutMortgage_Stuckey (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County
Pli L gii)
a FOR DEDUCTION FROM ASSESSED VALUATION
�'1 State Form 43709(R11/6-09)
Presaibed by Department of Local Government Finance
File Mark•
INS7RUCTIONS: - I
Forth fled '1.
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 Properly Must file during the year for which the deduction is sought. ❑ r.unty • •tar
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months • I�, _/1r3,,;�i
before March 31 of each year the deduction is sought
lB II r . OR
See reverse side for additional instructions and qualifications.
Appf�n{.( j agnC/J uy <:. vxrse side)
Key Di/Fiber F-- desaiplion Record number Page number
n /liiti< �.� � •-Oat- 3_ . 0� 3- op,_ 07.6 g 3 -7,2?
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract' ebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,current year data of appacatiw✓J� _zoo legal or�uYede owner?
r. W ❑ No
If no,what's his/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 th property in question:Annually Assessed
Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller0 Q /1 20d �1 / /a/��]-�c���'
Address of mortgagee or contract seller(number and fee/city stare,and ZIP code) t�I /(^(�U
Name of assignee or other owner or holder of mortgage
0/5V s L a.s &1�/
Address of assignee(number and sheet,city state,and ZIP code)
d03 S. /Q.s So -P-M P-P-a-)
Does applicant own property in any other If yes,what county? - What Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current year? ❑ Yes
❑ No
-- - _____ COUNTY AUDITOR
STu c)< /hircy&c c)
6007—y in 20 20 20 20
/3 )p( 3 7)04 County Date(month,day.year)
• nd foregoing information is true and correct and that the applicant is a resident of Indiana and
date application is filed.
$prrayre(owrrgrs rWrre)r �� Date(monfi,day.year)
/FUU77f/rasiddenn1,`t'adddre ofiall\ppbcacant num rand shee stare,and ZIP code)
203 wn51ti-Mori . are-no(v i l.(P 1 \k) U4-1(ng 3
Person authorized by duly executed of Attorney or by IC 6-1.1-12-03 I Date(month,day,year)
Address of authorized person (number and sheet,dry,state,and ZIP code) .