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STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court DU ;' '_� ". ';1!I
i` FOR DEDUCTION FROM ASSESSED VALUATION Sub to i a 'acce a �r
..-.:,:•‘• 1d° State Font 43709(R11/6.09) I P ce or tea .fer
Prescribed by Department of Local Government Finance •a •!_
[Y �—
F rte_ �• I
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is boat-.I • i%;1/ j: 2 �. 1 r;01
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought j ' P/Mrv,�Qlf,Yp;;::.on County
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)mor . i BSp .- U R D R
before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Applicant(owner or cone ` reverse side)
axing District ■ Key!#amberI desaipoon Record number Page number
. ∎ - - •. la - o _ : 1 �a
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,parent year March 1,current D)
t y�eaar date of application I legal or equitable owner?
6 DD') I Ores ❑ No
If no,what is his/her exact share of interest? If owned with someone other than sparse,indicate with whom
If name on record is different than that of appecanl,indicate below: s property in question:Annually Assessed
Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
ere of mortgagee a contract seller
tf� 0 _ - _ter S�.�n
'Address mortgagee or cont{�}t seller(n and sweet,city,sea and ZIP code)
Name of assignee or other owner or holder of mortgage /mi.: �—�
Address of assignee(number and street,city,state,and ZIP code) •'" - f
54_4/52./
Does applicant own property in any other If yes,what county? . What Tad;
county in Indiana? ❑
Yes lo U .53 6 o No
COUNTY AUDITOR
Deduction approved in the amount of - •
20 20 20 20 20 20 20
•
Signature of County Auditor • County Date(month.day,}ear)
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 aforementi ned property on date application is filed.
,�$/lo]/lnature(o fide name)/ ,{ A Date(month,day,year)
FW resident address of applicant( 'and street C_ lcty ssta,te, d ZIP Dade) i
7 c8 Gv, s,4 4P a f n'rilfo n, 4f'7&70
P n authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month,day,year) •
Address of manned person (number and street city,state,and ZIP code) .