HomeMy WebLinkAboutMortgage_Vickers o-isr STATEMENT OF MORTGAGE OR CONTRA PE8TE tl) County Township Year
FOR DEDUCTION FROM ASSESSED VALU rtIC�J N
t: State Fonn 43709(R11/6-09) 1LJ n I
Presmbed by Department of local Government Finance
JAN 3 2014 File Mark
INSTRUCTIONS:
To be filed in person or mad with the Court Auditor or County Recorder of the con where the Farm reed with:
Pe by 4' H h propertyalocated. .�-�/
Filing Dates: 1) Real Property Must file during the year for which the 1__I County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property- _ ehre(12)months
before March 31 of each year the deductions sought ( iBSON COUNTY AUDITOR County Recorder
See reverse side for additional instructions and qualifications.
AppGCant(ow er or contract b iillgi.u' L/I ]T 7 / / /
•Key desaiption Record Page number
do/�13a/-000.o73�a 3 go 9a
Assessed. value of property as of Abnpane/Contgrebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the appit the sole
Math 1,current Mardi 1,corren //oho D date of appr�6on legal ❑
Uv Yes 0 No
K 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 Home(IC 6-1.1-7)
Name of mortgagee or contract seller EQ3 h/]
Address of mortgagee or contact seller(number and sheet city,sate,and ZIP code)
Name of assignee or ode owner or holder of mortgage
Address of assiig�neee�(nnuumbber�and street city,state,and ZIP code)
loairdc(.I .9thcJ) &A .
ao r 3 that county? What Taxdng Debia? Has this deducbon been requested on property
Drawer �I Q p ❑ Yes ❑ No
Card NO. 14010 COUNTY AUDITOR
. itIA,(Mc 0-
20 / 20 20 20 20 20 20
Sig / y Audjto� 1 �'6 County Date(month,day,)ear
I/We certify under the penalty of off peeeijury that the raabo`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.
naosxiCco 6y's D
Date(north,day,year)
jii V60 el
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 / I Date(month,day,year)
Address of authorized person (number and street city,sate,and ZIP code) .