HomeMy WebLinkAboutMortgage_Mullen n,_.• STATEMENT OF MORTGAGE OR CONTRACT1{D ED S D County Township Year
_' t FOR DEDUCTION FROM ASSESSED VALUATyiOINNJ���
State Form 43709(R111609) 2��3
4.41C Prescribed by Department of Loral Government Finance
NOV t•2 File Mark
INSTRUCT7ONS:
b be filed in person or by mail with the County Auditor or County Recorder of the countyr(Lep is located F filed with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is soug�t}OIY/ AUDITOR IA County Auditor
2) Mobile/Manufactured Homes not acrossed as Real Property G,I �-lu klehyelve(12)months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications.
Apt Lmer or contract buyer-see�m/styri�c>ims on revr�sesiiel/,
T/a�" D" Key number/legal des:ipdon Retard number Page number
( "/7-64/44-1i-ce dio—ill- (�-7- 'loclool . I -GY) 1- I 13 53rG
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Canted indebtedness unpaid as of Is the apprrrant the sole
March 1,gnent year Mardi 1,cement year date of appGwtim
—7 legal or equitable owner?
�'0 COD 1 ❑ 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 different than that of applicant.indicate below.
Is�,t,he property in question:Annually Assessed
1E1 Reel Property ❑Annually Assessed
• I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller�1
C CIAJnit1.aire eZ ‘/ ^LIgA.,0 Fe LI
Address of mortgagee or contract seller(number and sheet,thy,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,coy,state,and ZIP code)
Does applicant awn property in any other If yes,what county? • I /�/� ��r j2J 'i /���/' i" I on properly
county in Indiana? ❑ Yes ❑ No / u I U�L73 /•)'�U r /
l�f '/61l t-1/1) ❑ No
COUNTY Q /
Deduction approved in the amount of. 1 J-53 V l:7
20 20 20 20_ 0
Signature of County Auditor • a.wnry Date(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/contract buyer of the aforementioned property on date application is filed.
Sig
(owner's hill name I Date(month,day,year)
Full resident of applicant(number and sheet, Sate,and ZIP code) n
0505 1.- /R5 �.� CL /
eat , 47660
Person authorized by duty executed Power of Attorney or by IC 6i1.1-12-0.7 U I Date(month,day,}ear)
Address of authorized person (number and street-city,state,and ZIP code)