Mortgage_Chandler •
4 . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'' :` FOR DEDUCTION FROM ASSESSED VALUATION
State ib d 43709 Department(RD m/6-09) FI I
Prescribed by Department of Local Government Finance 1ryp
INSTRUCTIONS: fJj;ET!D
Ws be filed in person or by mail with the County Auditor or County Recorder of the county where the DEC 2 Rte ''
Pa Y ty ic Properly is located. 1. 2 a,
Filing Dates: 7) Real Property:Must file during the year for which the deduction is sought
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months unty Auditor
before March 31 of each year the deduction is sought. - II//� ounty Recorder
See reverse side for additional instructions and qualifications. JV7W3
APPfg�nI(owner or contact buyer- res¢ 'wtsmreverse e) CInCOI COUNTY AUDITOR
awg 0 Key number/legal d " den Record number Page number
CUt r--) a6 - o20 - 36- 364 - DOO . ' 10 , 00 / 2013 (0039
Assessed value of real properly as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appfrant the sole
Mardi 1,anent year Mardi 1.cement year r: date of application SOI 0 0 0 legal or Yes D N
❑ 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 bedew Is the
property in question:Annually Assessed
❑Real Property ❑Annually Assessed
I Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
7 l gi.se..4/
Address of mortgagee or contract seller(number and street,city.s ,and ZIP cod
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant win property in any other If yes,what county? What Toxin y\/2
county in Indiana? {f Jrx'..,)14 4l[
❑ Yes ❑ No Drawler NO.. 1
COUNTY AUDITOR (00S•{
Deduction approved in the amount of: C a f'd NO. .
I'
20 20 20 20 20 20 20
Signature of County Auditor . County Date(month,day,year)
/Wf a 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 contact buyer of the aforementioned property on date application is filed.
Signature(ownerY fue name) //�1•'//��((�� 1/ p �y Date(ngnth,day,year)arpl ell resident address of applicant(number and/ O5 ZE / 0509 street ilNI�I,ke, Trtr ' L19
Person authorized by duty 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) _