HomeMy WebLinkAboutMortgage_Fenwick I
af. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coin shj Year
• FOR DEDUCTION FROM ASSESSED VALUATION
=_"i'.'S�,-�J State Form 43709(RU/6-09)
1--- -:-' Presoibed by Department of Local Government Finance
File Mark
INSTRUCTIONS: 1 , +_4., I
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought. 0 •u ,. . •itor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months .i
before March 31 of each year the deduction s sought I ', rpr,7j`?7'?lRecorder
.t a S '
See reverse ....
11 , for additional instructions and qualifications. GIBSO - - ; -•
App (Ii estr aoaon. : , Lcc ek 1
Fi __/, Sr /0?-0"/ /0.5 64O Qom?! �a/ Page o3
Assessed robe of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year daa of appf�!. 9905 Id-2 legal or liable O
17/ Yes No
If no,what is his/her mod share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of appricant indicate below Is ale property in question:Annually Assessed
I�[Real Property ❑Annually Assessed
1 Mobile Home(IC 6-1.1-7)
Name of mortgagee or moved seller ��1 A/��
Address of mortgagee or=intact seller(number and street, .state,and ZIP code)
Name of assignee or other owner or hdder of mortgage
Address of assignee(number and street coy,state,and ZIP cede)
Does applicant own property in any other 'If yes,what county? What Tasting District? Has this'deduction been requested on property
county in Indiana? ❑ Yes ❑ No for currant year? ❑ Yes
❑ No
__ 1
--C— t 120 20
�L. L 1 Date(month,day,year)
‘A ad that the applicant is a resident of Indiana and
C31-3
&CI 0 i
r I Date(1/I�I1y
v' I Date(month,day,year)
4