HomeMy WebLinkAboutMortgage_Malotte (2) f.a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
I! State Form 43709 Department/6-09)
Prescribed by Departrrhent of Loral Government Finance
File Mark
INSTRUCTIONS:
Form filed with:
' To be filed in person or by mail with the County Auditor or County Recorder of the co4('ylwti6 t 1t 3oerty is located.
Filing Dates: 1) Real Properly Must file during the year for which the deduction is sought
unty 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. I W��l•
Appacant(owns T• I�1� .. i �met, Sni / i r r 91 1voi.
i9 ,, numb lgAlwn Record
/ 3zn— OCD OSD—O u number I%y
March a Ids property as of e/Contract indebtedness unpaid as of Mortgage IConta BWebtedness unpaid as of �or equitable the
e sole
Oa) I ❑ Yes ❑ No
If no,what k his/he exact share of interest?
ti Oa)
owned with someone other than spouse,i ind'i ate with whom
I
If name on record Is caller-ern than that of appecant,indicate below. Is the property in question:Annually Assessed
//��y//��qJ/'�/� ❑Reel Property ❑Annually Assessed
OW Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
�,_...__._�„,r.,,„n err and street,oily,state,and ZIP e)
-
Drawer NrO96(5
1��
/♦1 (,,JJ ide)
•
Card NO. L L g I ,what county? - What Taxing District? Has this dedu[ban been requested on property
for current year? ❑ Yes
❑ No
COUNTY AUDITOR
Deduction approved In the amount at
20 20 20 D20 20 ,20 20
Signs* • • County • /nor/ / / ' ! Cainty I Data(month,day,year)
•
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. I
��/{[SVO�rew ownels rmm�e){�//� -�//V/� soak) Date(month.day,year)
Full tad appecait(number and street. and ZIP code
i° .(Z7g Z 5- Sep fi A L r2, e4t) hi r ( l�l/ I zb�9
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of auuodzed person (number and street city,sate,and ZIP code)