HomeMy WebLinkAboutMortgage_Calvert STATEMENT OF MORTGAGE OR CONTRACT INDEBTE - 1j�'�ty Township Year
1 FOR DEDUCTION FROM ASSESSED VALUATION ®j J
�t '+� State Form 43709(R11/6-09)
Prescribed by Department of local Government Finance
INSTRUCTIONS: FCB 124 2014 File Mark
Form Ned with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is •a t_.,
Frg Dates: 1) Real Property Must file during the year for which the deduction is sought. . ,4^R-'F ❑ County Auditor
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2) Mobile/Manufactured Homes not assessed as Real Property Must file during. - • ` a fr +1 IT O•
before March 31 of each year the deduction is sought N COUNTY A ❑ County Recorder
See reverse side for additional instructions and qualifications. O(gS0
buyer-see e u e)APP6mni erorKh C
T erg District Key number
/legal description Record number Page number
a&-ir- 36, '5'03-000- Lodi 009 Rot 5 6L 95
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant lure sole
March 1,anent year March 1,current year I1 date of applotion legal or equitable owner?
/Lia 5d
7 ❑ Yes ❑ No
If no,what is his I 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
giReal Property ❑Annually Assessed
. Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract rlivitto
Address of mortgagee or contract seller(number and street tray.state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and meet bey.state,and ZIP code) _
Does applicant own property in any other If yes,what county? - o / ., don property
county in Indiana?
❑ yes ❑ No S ❑ No
Deduction approved Drawer NO••••••
.........Deduction approved in the amount of /,��///�/7
CardNO. .... YO+•••'........
20 20 20_ 20_ 20
Signature of County Auditor ' t^4^m,nay,year)
I��
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 application is filed.
Signature(mimes )
Date(month,day,year)
i L
Full resident ress of applicant(number and street city,state,and ZIP coda)
X 4 (01 S QA)1r pM,w. -or, IP 141(rii
Person authorized by duty executed Power of Attorney or by IC 5-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and meet city state,and ZIP code) _