HomeMy WebLinkAboutMortgage_Mann Fa . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
_,tsar FOR DEDUCTION FROM ASSESSED VALUATION T
=_--_ t'.' State Form 43709(211/6-09) I L h1 g �,
S t3 d Prescribed by Department of Lod Government Finance
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is 1,,,{�!ArT Form filed with:
Filing Dates: 1) Real Property Must tile during the year for which the deduction is sought. -UtiT 10 20E County 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. - �J1� C unty Recorder
See reverse side for additional instructions and qualifications. lI4Al/
� opqon CIBSON COUNTY AUDITOR
Appfaan Lacs yyer see i e)
Taxing Distri�j, � `.. Key number/legal description Recoy,number Page number
�+,t .7�Y hJ aCo-/q 'i -A03 -ool. AS 2- - 0 A6 „(D 3 LfoS
Assessed vale of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Manth 1,current year March I,anent date of application legal or equitable owner?
/ ,Lou 00 0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
•
If name on record is ddferent than that of applicant indicate below: Is die property in question:Annually Assessed
❑Real Property ❑Annually Assessed
- Mobile Home QC 61.1-7)
Name of mortgagee or contract seller C
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Dialler N O.Q01.3
Name of assignee or other owner or holder of mortgage 2,
Address of assignee(number and street ca):state,and ZIP code)
Card �V I 1
...........
1�016g0.co....
Does applicant own property in any other If yes,what county? - What Taxing District?
m I tm�m...__ .
R
manly in Indiana? ❑ Yes ❑ No for aens yea
❑ Yes U No I
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20_ 20 20
Signature of arty 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 contract buyer of the aforementioned property on date application is filed.
„Iles re o efs At name) Date(month,day,year)
r,.
A,Oull resident address of applicant(number and street,city,state,and ZIP code)
7S.5-0 t 5 La E IL) F><. Q14nch tW 1176112
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 f Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) •