HomeMy WebLinkAboutMortgage_Englert STATEMENT OF MORTGAGE OR ED VAL CT�t DN Court Township Year
fair Vii' FOR DEDUCTION FROM ASSESSED VALUA ON b p
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance FEB 2 0 2014 File Mark
INSTRUCTIONS:
Form
lb be filed in person or by mail with the County Auditor or County Recorder of the county here th • orated.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is so County Auditor
2) Mobile/Manufactured Homes not assessed as Real Propertj ® atmaths
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional• dons and qualifications.
Applicant(owner or G b / I L(�/�/( �..1[/(�] /y�/� /� Q�num Ta Key number/I descnOU— i{�jy/ —0010• 29%Vog ue aq;
Assessed value of real property as of Mprtgag .7VV-,J1I/..::indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1, ir. ,..,�^^^ date of application legal or equitable owner?
0/c O El Yes El 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 ❑ArnuallyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /'-•' ^/(,
Address of mortgagee or contract seller(number) saes;illy.stag--'.>IP code)
Name of assignee or other owner or holder of mortgage -//�
Address of assignee(number and street.city,state,and ZIP code) _ bra wet 1\t O J� dys
Does appficant own property in any other If yes.wl 1%•: /`�••••• ••.• eduction been requested Pn prapenY
county in Indiana? ❑ Yes ❑ No Card IV p• .. 7� t Year' ❑ Yes ❑ No
Deduction approved in the amount of
20 20 20 it 20 20_ 20 20
nahue of Caa /i.. Camty Date(month.day.year)
1411 I k di
I/ e 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 mart buyer of the aforemen.ed property on date application is filed.
SIgnatu �) / Date(month,day,year)
/ w 5a address
S . G(na r1..street.a n:.s t a.t\and Z I P n o d e) fr 14 ) / `/
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(north,day,year)
Address of authorized person (number and street dry,state,and ZIP code) .