HomeMy WebLinkAboutMortgage_Fravel (2) ae;�a�>'`�. � STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
�. ,, t State Form 43709(R11/6-09)
- Presented by Department of Local Government Finance LE 1,1
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is boated. s Farm tied with.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. s_' may Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications. niPSBN�,' �
Ap. weer or contract buyer-see --- . on reverse side) , / AUDITOR
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March 1anent of year ppprrroy as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
// year date of apPGcaWn rr �1 legal ❑ fade❑owner?
/ C�//y,/// Yes No
If no,what a his/her exact share of interest? If owned with someone other that spouse, rate with whom
If name on record is different than that of applicant indicate bebw lsls/y�property in question:Annually Assessed
Real Property ❑Annually Assessed
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Name of mortgagee or contract seller
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Address of mortgagee or contract seller(n •'1.- and stree ,state.and ZIP code)
Name of assignee or other owner or holder of mortgage /y//� /j1/// ���j '/7J/J(L
Address of assignee(number and street,ray,state,and ZIP code) u� -K.•c%c-G A///�-t /6-0fi—J `e{'2
Does applicant awn property in any other If yes,what co ty? • What Taxing District? Has this d been requested on property
county in Indiana?ten-..._ I_NO for current year? ❑ Yes ❑ No
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Dra�w�er Not... C, lt: ,
DeductMn appmn
20 Card.Nn. ... `�3 20 20 20
Signature of Ca . - :ounty Date(month,day.year)
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I I We certify under the penalty of perjury that the above ano rurey.n,, ...._._etion 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.
wv jlull rem e) �S , Date(month,day,year)
X F� address of t nu W street city, e'and ZIP ) ! 4 n b �O
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Person authorized by duly executed Power of Attorney or by IC 64.1-12.0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .