HomeMy WebLinkAboutMortgage_Bowden (3) 4 . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709(R11/6-09)
Presmbed by Department of Local Government Fuwtre
ark
INSTRUCTIONS:
To be filed in person or by marl with the County Auditor or County Recorder of the county where the property r's.)gc�teQ, Form filed whh:
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought U t 1. G 6 z I�3 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the fweNe(12)months
before March 31 of each year the deduction is sought. A I I • County Recorder
See reve - side for additional instructions and qualifications. J/mmt
Aram it or contract buyer-see resrntli on revg u side) • GIB O ICCUBnerffOR
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T Dietwt -y number I legal desoiptMn Record number Page number
` a.A.Go - a(o • n- 3/ - woo - 000, 7 /4 -coy /3 Lo `l744
Assessed value of real property as of Mort gage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness;unpaid as of Is the applicant the sole
March 1,and year March ,anent year date of aPPlraton ' legal or equitable owne?
�S Soo I ❑ Yes ❑ No
If no,what is his/her exact share of interest? S if owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant.Indicate below. -I Is the property in question:Annually Assessed
:rIon,af IV.D Anna,alryAssessed
Name of mortgagee or contact seller I Jo�}J "^ e nC 6
ii ' `
Address of mortgagee or contract seller(number and sheet city,state,and ZIP code) iE"7 j p Gr I .
Name of assignee or other owner or holder of mortgage `+�-I-,f-� // '
/,3 - 64/17(1 -
Address of -gnee(number and sheet my,state,and ZIP code)
9 •
Does applicant own property in any other If yes,what county? • What Taring District? Has this deducoo• _
county in Indiana? ❑ Yes ❑ No aururd Yea(! ❑ Yes U No
COUNTY AUDfTOR
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Deduction approved In the amount of:
I
20 20 20 20 20 20 20
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Signe of County Auditor County 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
owner I contract buyer of the aforementioned property on date application is filed. 1
xSlgnatue(owner's(t tree) //R //J 1 1 '7 2 Q Date(month,day,year)
Full d��-of appfica (nummber street (4/a✓ /d T�/ I/� / J / I •
PeriooS/�U,,n authorized by duty exewlted/d Power of Altarneyf'-lr by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet city,state,and ZIP code) .