HomeMy WebLinkAboutMortgage_Frederick II r f.�, . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11 16-09)
Presmbed by DeparoneM of Lod Government Finanoe
File Mark
INSTRUCTIONS: till Wi 14
Tb 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 Pm petty:Must file during the year for which the deduction is sought. ❑ County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought y �."... A.It ->•• •er
See reverse side for additional instructions and qualifications. Claw -r ra U DI TOR
Applicant(owner buyer-see restrictions on side)
a w AaABA _itn
Taxing District number I legal description Record number
lo- 05-33- 100-DD3.9 %-0 1 I LI crombe
Assessed value of real property as of Mortga999a/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,orient year March 1,r-_year� date a(aPPtion legal a equitable owneR
pI ❑ 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 ddferent than that of applicant.rid ter�e Is the property in question:Annually Assessed
• l�/ ❑Real Property ❑ArwuzOY Assessed 6
Mobile Home e(IC(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contrail 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 city,state,and ZIP code)
Does applicant own property in any other I� - Has this deduction been requested m property
county in Indiana? ❑ Yes ❑ 1 for cement year ❑ Yes ❑ No
1 /.
Drawer NO ,(• .•
Deduction approved in the amount of
Card NO. .:0
20 20 ............. 20 20
4�iao,aro. ci
Signature of County Auditor r I 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 I contract buyer of the gum,nerltioned property on date application is filed.
re ) r (month,day.year)
. col oenoa t(numbera-i state,and L e) nn
nQID4 Al Conn a- WcP �Yvt47b70
Person authorized by duly executed Power of Avomey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sweet.city,state,and ZIP code) .