HomeMy WebLinkAboutMortgage_Frey a, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County F .1Ship� r
FOR DEDUCTION FROM ASSESSED VALUATION Y
t' State form 43709(RU/6-09)
Prewibed by Department of Local Government Finance
File Mark
INSTRUCTIONS: t ;
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. F. nett enr
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. I Co u ty do
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 corder
See reverse side for additional instructions and qualifications. GIB' • •
t(owner or contract buyer-sJ'�reesstrictons on�reevveerse side)
r 'str- iN I Key number Ngal description Record number Page number
c-e� � ac. - N4- 3S 't"))bh - Orin /solo - 6; iboR 31.11
Assessed vatue teal property as of Mortgage I Contact indebtedness unpaid as of Mortgage I Conuact hWebtedn unpaid as of Is the applicant the sole
Mardi 1,anent year March 1,current iyear date of application legal or equitable owner?
.1`.. C> b 72:, V1'es ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
'a;
If name on recent is different than that of appbcant.'indicate below Is the property in question:Annually Assessed
gpleall Property ❑/uuivally Assr✓"'ed
I MoblLa"' 6-1.1-7
Name of mortgagee or=tact seller . I /
:iii : _ _ 1.
Address of mortgagee or contact seller(camber and street city,state,and ZIP code)
I Name of assignee or other owner or holder of mortgage 20,
Address of assignee(number and street city,state,and ZIP code) \0 l
Does applicant own property in any other If yes,what county? Mat Taxing 1h VI • ..,property
county in Indiana? �i�
Dyes �Q• J Yes o
�C\ \
COUNTY AUDITOR 1 C'^
Deduction approved in the amount Deduction et
I
20 20 20 20 20 120 20
Signature of County Auditor - County I Date(month,day,year)
I 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
Amer/contract buyer of the aforementioned property on date application is filed. I
fignau owners full name) I Date(month,day,year)
fresid t address of appfoant(number an0 1 and ZIP code) S 9
'73� ' �� ? a
authorized by d executed Power of Money or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of author zed person (number and street dry,state,and ZIP code)