HomeMy WebLinkAboutMortgage_Harris �aa . STATEMENT OF MORTGAGE OR CONTRAC rQP DtB�ED jS� J County Township I Year
cf• l'fA FOR DEDUCTION FROM ASSESSED VALU I 0 �J A
State Form 43709(R11/6-09)
Prescribed by Depamnent of Local Government Finarre DEC 4 2013 File Mark
INSTRUCTIONS: -filed with:
b be filed in person or by mail with the County Auditor or County Recorder of the count, ere i Form
P Y N h L 1 •„, is located.
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is s•F:., i/ Pr 18( County Auditor
2) Mobile/Manufactured Homes not assessed as Real ProperQC' •T- , + : r .`P"PICSfD17)OSipths
before March 31 of each year the deduction is sought "i County Recorder
See reverse side for additional instructions and qualifications. /�cS Applicant Cw� f buyer �!�y,�/re�,aJ ) W V l.(.3
T`l..-f(.(Distr�j I(_ (�r ,, Key number 6)(0(`tY1,- 3 0 3 COO .5 86-f�o5' Tag Pagg da
Assessed(value of real(^�An property as of e/Contract indebtedness unpaid as of Mortgage/Conuaa indebtedness unpaid as of Is the appit the sole
Math 1,=rent year Max Gt I�.t�y�� )OT date of app�tion legal or equitable ov.TraR
� t ”' O 0 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 the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• r� Mobile Home QC 61.1-7)
seller Name of mortgagee or contract e�I.d
Address of mortgagee or contract seller(number and street,crty,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
.Men -.Jt�G'�T�
Does � l ' / / L G mtyl - What Taxing Dstnct? for Has a eduction been requested an property
count Y ❑ Yes ❑ No -
6 5yd n COUNTY AUDITOR
Dedtn
20 1 20 I 20 20 20 20 I 20
Signature of Aud �� //, .County Date(month,day,year)
I I We certify under the penalty of JpYe�rjjuurrryy that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and
Amer I contract buyer of the aforementioned property on date application is filed.
Signature(o is fug name) Date(month,day,year)
Y1 �ss Nam„
Fu0 residenl address of uCrt(number and street,cttY.state,aM`rZIP code)U ( , {- "l( � 2 p),
Person 111 ,
W cJtardt. executed Powepf lIa byAlUl 2-07 / \c.vbs ` JH I (L13 / y.year)
Address of authorized person (number and street,city,state,and ZIP code)