HomeMy WebLinkAboutMortgage_Kates s. STATEMENT OF MORTGAGE OR CONTRACT IND N SS . �, Township Year
FFFofAti FOR DEDUCTION FROM ASSESSED VALUATIO !�,
State Form 43709(R11/509)
Prescribed by Department of I Government Finance JAN 1 7
File Mark
INSTRUCTIONS:
a Form Ned with:
R:.be filed in person or by mail with the County Auditor or County Recorder of the county whe 1 : e pro t,40 1p`-. "'•.
Filing Dates: ,) Real Property:Must file during the year for which the deduction is sought. J'ThP County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property museivggepc tl i ,„.t tiAcTfitireR
before March 31 of each year the deduction is sought County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or buyer-see restrictions on reverse side)
q- Kai-Mean Kafe,S
rl- ng Disrtrl Key number/legal description Record number Page number
eli i 2.t- Zo -/a-3Oo coo $09 00 / / ", /n7/ 9
Assessed value 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 data of application legal or equitable owner?
800 D ❑ Yes ❑ No
if no,what is his I 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 belowc is the property in question:Annually Assessed
Real Property ❑ Sect
Mobile
Name of nir contract seller
On '
Address of mortgagee or contract seller(number and street.city.sate,and ZIP code)
Name of assignee or other owner or holder of mortgage • " /,�,, _) �/ E —
_ 1 `1- -t �/� / /-
Address of assignee(number and street day sate,and ZIP code) re`� , t.-,Gr//'7`") Yl
ANN
Does applicant own property in any other If yes,what county? • What Taxi, I^ I Q erty
county in Indiana?
El El No i3 W
No
COUNTY AUDITOR
Deduction approved in the amount ot'.
20 20 20 20 20 20 20
Signature of County Auditor • County Date(month,day,year)
I l 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.
SkinaW (or et A Date(month,day,year)
Full resident address of applicant(number and street,city,state,and code)
� „ °476�6 73a9 S Rao F )
Person authorized by duly executed Power of Attorney or by IC 51.1-12-0.7 Date(month,day,year)
Address of authorized person (number end street,city,state,and LP code) .