HomeMy WebLinkAboutMortgage_Leister _`mod: FOR DEDUCTION FROM ASSESSED VALUATION INDEBTEDNESS County Township $�Yeeaarr
11 State Form 43709(R11/6-09)
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Presaibed by Department of Lod Government Finance A-A RRR A A
File Mark
INSTRUCTIONS:
F. 7
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. I County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months r
before March 31 of each year the deduction is sought 11%t -iI'/?4 j " 'Cr•See reverse side for additional instructions and qualifications. GIB• ' • e ' • • li I •R
KeKey^number/legal desaip ,p // Record number Page number
01 -/�a 3d6—000. loG-oa 4oi 3 A 923
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the apparanl the sole
March 1,anent year Mardi 1,current year date of aPparation legal or equitable owner?
0.50 v ❑ 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 applicant,indicate below Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(1C 6-1.1-7)
Name of mortgagee or contract seller ey/ / ca /"t
Address of mortgagee or contract seller(number anan-�dduat t/yeti/dry,/ state,�andd ZIP AA.
Name of assignee or other owner or holder of mortgage
d2--3 —// /. 9i/lc
Address of assignee(number and street,thy,state,and LP code)
Does applicant own property in any,other If yes,what county? • What Taxing District? Ras this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for current year? El yes ❑ No
I r - -- — -- COUNTY AUDITOR
^,
.�/O l 3 20 20 20 20
Drawer NO "`///" 1111
Sic 2 c� County Date(month,day,year)
Card NO. ..••+•'•'•l•• iegoing information is true and correct and that the applicant is a resident of Indiana and
application is filed.
SI9 Date(month,day,year)
Fu resident address of applicant(numb a •sbae4 city,slate,and ZIP code)
35/90 W r ? .1. F,,,49,.,, .t .I_� , A/76 /$1
Person authorized by duly executed Power of Attorney or by IC 6-L1-12-0.7 / Date(month,day,year)
Address of authorized person (number and street,city,state,and LP code) .