HomeMy WebLinkAboutMortgage_Moore (9) s. . STATEMENT OF MORTGAGE OR CONTRANEEES County Township Year
.� f0 FOR DEDUCTION FROM ASSESSED VAL I
Sao
Form43709 Rh /rps) 2 6
2013 Prescribed by Department of Local Government Finance NO V
1 FarFile Mark
INSTRUC77ONS:
m filed with:
W.)be filed in person or by mail with the County Auditor or County Recorder of the if .: r; .. .pe is located. �/-14 Ring Dates: 1) Real Property Must file during the year for which the de ,'. (Pq 1 I lJ County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property �, r : g4}ft® rap months
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications.
Appfimnt(• or Mrtha buyer-see restrictions on revers side)
4 .- / Key number!legal desoipbon I Record number Page number
Z4-/, -07-.30 o00 / 8'c2 oak I /sp ,51raa
Assessed value of real property as of Mort gage/Contract indebtedness unpaid as of Mortgage/Contract Mdebtednesi unpaid of Is the applicant the sole
March 1,arrant year March 1,anent year data of application legal or equitable owner?
/O °on I ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone otter than spouse,li di ate with whom
If name on record is diterent than that of applicant indicate below-. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
I Mobile Horne QC 6-1.1-7)
Name of^oz e�e//or _seller
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Address of mortgagee or contract seller(number and street,city,state.and ZIP code) rh�T
Name of assignee or other owner or holder of mortgage �VV • Atka 8
Address of assignee(number and street,cM,state,and ZIP code) `i - Syr r d 1 A
r V
Does applicant own property in any other If yes,what county? - • ted on property .
county in Indiana? ❑ Yes
❑ No I Yes ❑ No
a -10 COUNTY AUDITOR • i B .
Deduction approved in the amount of
20 20 20 20 20_ 20 20
Signature of County Auditor • County ( 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.
S(gpature7(57W name) Date(month,day,year)
/}( a. qp 1/- z6,—i3
Full resident ad tiro t( um rand street city, -�tsp.•ZIP code)
3Aces —5- �� /LtmciLLyiSliC) 'x7070
Person authored by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code)