HomeMy WebLinkAboutMortgage_Frederick STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
f' FOR DEDUCTION FROM ASSESSED VALUATION
1 J State Form 43709(R11/6-09)
��R�is'7 Prescribed by Department of Local Government Finance F' I LEA ',i
INSTRUCTIONS:
with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Forth filed
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought �aN 2 tin, onty Auditor
2)Mobile/Manufactured Homes not assessed as Real Property.Must tile during the twelve(12)months
before March 31 of each year the deduction is sought - ❑ 'linty Recorder
See reverse side for additional instructions and qualifications. I, v9'17111.
Ap (t owner sea anrse side)
CIBSON Cuury I Y AUDI I OR
istrict Key number/legal description Revd number Page number
�. to-AL) o a � / a - tee- aoo - ooh. 39to-0a7 O r3 (07 / 7
Assessed value of real as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mach 1,current year Marti 1,arrest yearI' /I date of application legal or equitable owner?
' Li ({, 0 o 0 ❑ Yes 0 N
If no,what's his/her end share of interest? fi owned with someone other than spouse,indicate with whom
If name on record S different than that of applicant,Indicate below Is the property It question:Annually Assessed
❑Real Property ❑Mobile Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and ' ,state,and ZIP code) `I-P ! •L I L(/<'/ ��—
Name of assignee or other owner or holder of mortgage
Drawer 1\iO..a.i —
Add of assignee(number and street,city,state,and ZIP code)
Pr Gv NE a. 0 - - to I .io 4-c _ • x`117 _
Does applicant own property in any other If yes,what county? - What Taxing D C`)I d I`r 0.
.....................
muraymIndiana?
❑ Yes ❑ No - _
COUNTY AUDITOR
Deduction approved In the amount of
20 20 20 20 20 20 20
Signature of Canty Auditor ` • County Date(month,day,year)
� (4✓ juat
I I W 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 II contact buyer of the aforementioned property property on date application is filed.
X SgnaVtuto i' ruff
Q ) triad Lek) Date(month,day,year)
�FA resident address of applicant(nun rand st ee4 state,and ZIP code)
1 4,3 >c 151)S r;an ti T7/ 474170
Person authorized by duty eeal&d Power of Attorney or by Ili 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .