HomeMy WebLinkAboutMortgage_Lofton (2) a STATEMENT OF MORTGAGE OR FOR EDUCTIION FROM ASSESSED VALUATION
INDEBTEDNESS County Township Year
State Form d3709(R11/6-09) F I
Presmbed by Depanrnert of Local Government Firerre
INSTRUCTIONS: h
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. F �rj ,,I()� i
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought County
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 - County Re rder
See reverse side for additional instructions and qualifcatans. GIRS(lnl rOUNTYAItDIIUR
Applicant wow a contract buyer--�estrc8pfs on reverse sida�% D \
Taxi DistraY Key her/legal description J Record number Page number
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value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,arreit year March 1,amen date of application legal air equitade amen
/ S 000 El Yes El 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
Mobile Horne(IC 61.1-7)
Name of mortgagee or contract seller 1
Address of mortgagee or contract seller(number and 4 dry,state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee tuber and street,city state, ZIP e)
F. ai 07% CI S
Does applicant own property' y other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? ID yes 1:1 No for current year? ❑ Yes ❑ No
COUNTY AUDITOR
Dedumon approved in the amount at
20 20 20 20 20 20 20
Signature of County Arditgr County Date(month,day,year)
I I We certify 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.
` Slgrcd(owrhehM ) (1 ��/y�py��\ Date(month,days year)
/) resident address of t(nu card 4 Wy, and LPmdel)
7(� ; Pe 1a1r L� 41G,`ta
Person authorized by duly executed Pow)of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city.state,and ZIP code) -