HomeMy WebLinkAboutMortgage_Bradley (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTNESS tnty Township Year
f. ;
`
Ci:n FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R""°9' JAN 27 2 14
Prescribed by Department of local Government Finance
File Mark
INSTRUCTIONS:
°j$t Form Ned with:
7o be filed in person or by mail with the CountyAuditor or County Recorder of the county sated.
Fring Dates: 1) Real Property:Must file during the year for which the deduction is(j4ROON COUNTY AUDITOR 5 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months County Recorder
before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Appficaol can uyer-sai restrictions on reverse side)It (Who
Taxing 0 'd Kay number/ pton Record number Page number
2 r/ di.o—/y— /R —ao 3 oa J . 11x9 -OO y) c O/V 30.
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the appfirant the sole
March 1,anent year Marr3r t rrpn3 date of apt legal a equitable wme?
5 —79 ❑ Yes El
exact no,what Is his I her exa share of interest? / If owned with someone other than spouse,indicate with whom
If name on resod is different than that of applicant.indicate below. Is the property in question:Annually Assessed
ear Property ❑Annually Assessed
Mobile Hone(IC 6-1.1-7)
Name of mortgagee ortVict seller
Address of mortgagee or antral seller(number and street ray,state,and ZIP code) -
Name of assignee or other owner or holder of mortgage V
Address of assignee(number and street,cat,state.and ZIP code) C . ••
l ••.
Dawet'
Does applicant own property in any other If yes,what county? . What Tax
county in Indiana? .. •••••
•❑ Yes ❑ No _ to
Card 10•
COUNTY AUDITOR
Deduction approved in the amount of
_
20 20 20 _ 20 . 20 20 20
Signature of Canty Auditor County Date(month,day,year)
I I 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/contract buyer of the aforementioned property on date appiication is filed.
l(owners hA name) Date(month,day.year)
` .eA./.4 4 ��
ent address of applicant(number and %al):stet-, ZIP...0)
119 h err m- _ . . _1 Y7• - /'
•n authorized by duly executed'• - of Attorney or by IC 611.1-12-0.7 Data(month,day.year)
Address of authorized person (number and street dry,state,and ZIP code) .