HomeMy WebLinkAboutMortgage_Bell STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
M = FOR DEDUCTION FROM ASSESSED VALUATION
: '_.�.('t State Form 43709(R11/609 nn
Prescribed by Departrnern of fecal Government Finance J �-y,
pp 0. e File Mark
INSTRUCTIONS:
wtharet pyqyi� Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county I v t wh?i qi L U I J located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. G L U I 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 - /1, I ❑ County Recorder
See reverse side for additional ipstnrctions and qualifications. CIOSO`/NN/��CQt)NTY nUUIIUR
Appfaant(owner or uyer see resfic> an r/G}s�e��p sid/�A_n A r� �y I ��
ITa 'atata `/•" /legal••dQ[`//•'(`_/ /a[30— aoo —� . oaa—a704.. Rage mmlbg/a
• value of real pmpery of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the apptrant the sole
Marts t,current year Manor 1,current data of aPPrinixa I legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? / n�� If owned with someone other than spouse,indicate with wham
CO If name on record is different than that of applicant Indicate below. 3 Is the properly in question:Annually Assessed
❑Real Property ❑Annually Assessed
)f i Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller
OW)�cde
Address of mortgagee or contract seller(number and street,city,state,a ZIP code)
Name of assignee+other.owner or holder of mortgage _ —
Address of assig 2)
Does applicant r
Drawer /Ni 0... /`--� requested m property .
What Taxing Distrv1? Has this deduction been
county in Indian •••••• for currant year? ❑ yes
// // ❑ No
Card NO. ...9J/tor 1
UNTY AUDITOR I
Deduction app
20 20 1 20 1 20 20 120 20
Signature unty Auditor . O •s/ / County I Date(month.day,year)
/We certify under the penalty oofff perjury that the above and foregoing information is true and correct and that the epplirant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
tune( wnem's hN name) Date(month,day,year)
Qe Q,C I Neve.n.h.tA aa, oi3
., ,a resident address of (number and street.city,state,and ZIP code)
394 t S. Brinca-tin, IN (-4-l1eR0
Person authorized by duly executed Power of Attorney or by IC 6t.1-12-0.7 I I Data(month,day,year)
Address of authorized person (number and street,wiry,state,and ZIP code)
I