HomeMy WebLinkAboutMortgage_Sollman (11) x.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township Year
�; FOR DEDUCTION FROM ASSESSED VALUATION
•, - State Form 43709(R11/6-09)
" ' Prescribed by Department of Local Gcwemment Finance
le a
INSTRUCTIONS:
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 O r T
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought cj 3Cou2t9nditor
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 for side.for additional instructions and qualifications.
Applicant or mrw�buyere see resvlobo on reverse side) CiB$Ory COUNTY AUDITOR
Keea a/legaA_3 - 09- 0100- oo/. yo9-o� � R / 3 X80 9
of realpmputyasof d• Mortgage/Contract indebtedness unpaid as of Mortgage I Contact trWebtedness unpaid as of Is the applicant the sole
, ¢year March 1,amen) date of application legal or equitable owner?
(O 0001 ❑ Yes 0 N
If no,what is his/her exact share of interest? I 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
Mobde Home(IC 6-1.1-7)
Name of mortgagee or contract seller w I
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) SOU-. A it)) DA U 9 G
Name of assignee or other owner or holder of mortgage Q/�(,
Alike=of assignee(number and street,city,state,and ZIP code)
/i-c77 V/
r N � 9- `E-/o , 51 A- c $66 SY.o.S3 1
Does applicant own property in any other If yes,what county? • What Taxing District? I
county in Indiana?
a?
❑ yes El No I .__
COUNTY AUDITOR
Deduction approved In the amount of:
20 20 20 20 20 20 20
Signs of County Auditor• / Canty 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/contract buyer of the aforementioned property on date application is filed.
. reture(o tuff rianre) Date(march,day,year)
Full resident address of applicant(number and street,thy,state,and ZIP code)
11137 S ,750 F &dLrfojt Iv 97639
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP Cade) .