HomeMy WebLinkAboutMortgage_Basham STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Af trarg!Wt] .r
if� ..
-;
FOR DEDUCTION FROM ASSESSED VALUATION it
V-u State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
�p r�r� �a ZU'L
INSTRUCTIONS: r - --
Fo i filed wine
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
FiTmg Dates: 1) Real Property Must file during the year for which the deduction is sought ��LL��ttd�R�OTrr�1
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months I BSO N `�Y UtXttyxemrtlMR
before March 31 of each year the deduction is sought - Ci
See reverse side for additional instructions and qualifications.
Appfcard Hiner or ra buyer-see on re e
Taxbg atria /legal ption number Page number
one 1 Co- t -i $ - �,ot- cacao, % Nl.- oa-1 dot 0)a
Assessed value of• + Mortgage//AContract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,anent year Marts 1. data of appGpton legal or equitable owner?
re. ❑ No
If no,what is his/her exact share of interest? if owned with someone other than spouse,indicate with whom
I'-"--^�+v in auestim: Assessed
If name on Herod is dPoatt than that of applicant,indicate below Annually
s
Name of rtorgagee or contract seller
r _ 1 (3 ?-1(-7
Address of mortgagee or contract seller(number and street,city state.and ZIP code)
- Co =
Name of assignee or other owner or holder of mortgage V uw ISC c( f
Address of assignee(number and street city,state,and ZIP code) ? N •
U
c
� N tS�P '
Does applicant own property in any other If yes,what county? • What Taxing Distdc (n co
oouruy m Indiana? I 0 No (n W @ �. 1-r !�
L.p Yes C •ai : �'�-' i`e-i vV
COUNTY AUDITOR > , //�� ^
Deduction approved in the amount of CO Q h /s/ 1 `,, Le
-
C) C to
L/� \
20 20 20 20 2 c- a(NI
131 "I COr. cc'
Signature of County Auditor ' County -0 r- 1 J{ ��JJ
I I We certify under the penalty of perjury that the above and foregoing information is true ar Q
owner I contract buyer of the aforementioned property on date application is filed. I�" f‘, _
Signature(owners ND name) I'LI1�' (`\j25 GEC ;t —
F resident address of t(number and street ary,state,and ZIP code)
/Sr' S , -/tt sr' O `alt-e
authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet.city,state,and ZIP code) .