HomeMy WebLinkAboutMortgage_Richardville a. STATEMENT OF�f FOR DEDUCTION RTG GAGE OR ASSESSED T A T INDEBTEDN County Township Year
� @f- State Form 43709(R11/t 6-09)
L E
Prescribed by Deportment of Local Government Finance
F
y File Mark
INSTRUCTIONS: nn ((,� 11 2013
To be filed in person or by mail with the County Auditor or County Recorder of the codh�blrhe e the property is located. Fain Ned with:
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 fit wring (12)months
before March 31 of each year the deduction is sought OR ❑ County Recorder
See reverse side for additional instructions and qualifications. ON COUNTY AUDIT
App&a^'n/t(o�wn—er nor contract buyer-see restrictions on reverse side) G)4S
Taxug 1 {(gum- tlJ Record number Page number
. � � 1 ( $ c3 - ` be)-c-s,aD. T - Co 13 3 -787
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,',rent year Mar44,current yearn date of app&c ation I legal oO equitable owner?
Mall, /"1i 3 . 60 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: i d
i d
Name of mortgagee or contract seller
(�ic4ARbu Lm MD°QL\ 3-1.1-7)
5. P .0-tor c.r. G S 6n k? SP m( GAO l I�'Jt
Address of mortgagee or ct seller(number and street,city,state,and ZIP code CSI"1 O
IAA I I Pe (42:5 Pccr-k1.cx1/4'1 Fl, y� J
Name of assignee or other owner or holder of mortgage 13 - 3 '7 89
Address of assignee(number and street.city,state,and ZIP code) tvq 1 a'3-
Does applicant own property in any other If yes,what county? - What T. "l )
county in Indiana?
❑ Yes No No .
COUNTY AUDIT(
Deduction approved in the amount of
20 20
Signature of County Auditor County 1 Date(month,day,year)
I l 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
Signature(Mowners fual�e)` / , 1 . ' • I Date(month,day,year)
resident address of appfira I(number and street,city,state,and ZIP code)
LIOL 1-1GL ki3QS.0 Sk-. Ft, Arctrc3.-t 1 N Lf 7Ib `F�i
authorized by duly executed Power of Attorney or by IC 6-1.1-12-03 I Date(month,day,year)
Address of authorized person (number and strneC city,state,and ZIP code)