HomeMy WebLinkAboutMortgage_Brown (21) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County I Township I Year
aw FOR DEDUCTION FROM ASSESSED VALUATION FILE D
s` 11 state Form 43709(R11/6-09)Prescribed Pribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: 1'401013 To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought 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. I , S IT1►Ir • -ecorder
See reverse side for additional instructions and qualifications. GI BSON COUNTY AUDITOR
Apprra. - or contract buyer-see --, reverse sid
T-. s strict 1 Key number/legal desorption Record number Page number
r'Q a� e e/—C)5— 3o?-/lb —603- boo — efo 2 l3 (,011
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of the applicant the sole
March 1,amen year March 1,current year data of n0036on / I legal or equitable owner?
floc ❑ 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 th property in question:Annually Assessed
Real Property ❑Annually Assessed
• 1 Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller (i/yI( Ol
Address of mortgagee or contract seller(number and Street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage JJJn,/JJJ, J�/, —/�/y
Address of assignee(number and street oily,state,and ZIP code) 1� r0ui cN I V - iO�Y '^',7
Does applicant own property in any other If yes,what county? . What Taring 1 'J 1
county in Indiana? ❑ Yes ❑ Na _
COUNTY AUDITOR I p G� —
IDelurdion approved in the amount of. 1 -31)1-) pekt -
20 20 20 20 I I - I 20
Signature of Canty Auditor County I 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.
tore(owner's ) I Date(month,day,year)
i Xi , /14{.tr--
X Full resident-. of applicannnttt((number
�^and street city,state,and ZIP code) t' f� �7
X (OP,c4 uNO7mEdb dulyeP executed A�ne�rbay IC 6-1.1-12-0.7 piw'Ce IbN 'IA) / )& f () Dale(month,dal year)
Address of authorized person (number and street dty state,and ZIP code) - _