HomeMy WebLinkAboutMortgage_Kimbrough (2) .-.•� . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
b' s :. FOR DEDUCTION FROM ASSESSED VALUATION
° c , State Form 43709(R1I 1 609)
Prescribed by Department of local Government France
File Mark
INSTRUCTIONS: ;� a a.
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. !r
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought '' r� ..u `• •. a•,
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months 111 before March 31 of each year the deduction is sought - e x•un R . •er
See reverse side for additional instructions and qualifications. .
Applicant(ovate . ".••I buyer- :-restrictions verse side)) I t
many '. Key number description -f;...:."4 OU "1 TOR
t., / 1- • - 003• - 111
Assessed value of real properly as of .•_/Contraa indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1,asrera year t • CO 1 D current year date of application legal or equitable owner?
❑ Yes ❑ No
If 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 contact seller r,v
Address of mortgagee or contract seller(number and street city.state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street dy.state,and ZIP code)
in any other '-- Has this deduction been requested on property
Does applicant own property y
county in Indiana? 10.1. "l •• for aurent year?
❑ Yes LJ`l,l r� 0 Yes ❑ No
D('awci 10....
Deduction approved in the amount of:
III 3Q ..
Canal 1O. .....
20 20_ 1 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I I We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed.
Signature(owners At name) Date(month,day,year)
I
F empaddress of applicant(nump(/a/r/art city,state,and LP code)
/// 'zed by"i/ �IJ. /cis'A
P ',thorned by dilly executed Power of by IC 611-12-0.7 Date(romp.day,year)
9�t 5 �� � 5r
ress of authorized person (number and city,state,and LP code)