HomeMy WebLinkAboutMortgage_Grau STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County t
ty 1i. FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Lod Government Frame
File Mark
INSTRUCTIONS: IF I
Form 1:: • :
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Fling Dates: 1) Real Property Must file during the year for which the deduction is sought NI Cou,b • .air
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months Yn ri+R ij
before March 31 of each year the deduction is sought - .1. :". .er
GIB .i , •
See reverse side for additional instructions and qualifications. -
Appfcan�( "'re`or contract buyer-see resMCli(p n��\RJn reverse side ��\] (,�1 1 a 1l/�`J l
r„� Q4 l A� ✓L 2 • M J
e......molar zt number/legal description Record number Page number
u� .3 b3 ‘a - 3 b� d aQ .al n - raa `� 2a Lai ��S Lk
ale of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
ttert ye ar March 1,current year date of application legal Mu tale owner?
t SJr)b01� es ❑ 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
4)Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address l f mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any other If yes.what county? • What Taring District? Has this deduction been requested—--� —_
county in Indiana? for�nent`n°�.--
❑ Yes [ 10 ---
COUNTY AUDITOR �.( I/3
Deduction approved in the amount of: n ....,�
DraNN'ef \0....
20 20 20 20 20 _ �7_6)4
Signature of County Auditor ' County
Cal d NO"..............
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
owner/con buyer of the aforementioned property on date application is filed.
`Signatu Ad/nemei� Date(month,day.Year)
P 7
Full dg^t rant(number and street city state,a ZIP j
�°// 1s/a8 5 . /SD uO /� � N-' `f743T
Person authorized by duly exewted Power of Attorney or by IC 6-1.1-12-0.7 Date(north.des year)
Address of authorized person (number and street city state,and ZIP code) •