HomeMy WebLinkAboutMortgage_Seibert (4) ,a . STATEMENT OF MORTGAGE OR CONTRACT IN h �i SS County Township Year
aka rs FOR DEDUCTION FROM ASSESSED V 10
State
sc Form 43709
De artm 1609)
Prescribed by Department of Local Government Finance
g
r1 ,tp14 File Mark
INSTRUCTIONS: Corm,filed To be filed in person or by mail with the County Auditor or County Recorder oXthe 8 2 1 F county when th pent'is located.
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sough• County Auditor
2) Mobile/Manufactured Homes not acre ssed as Real Property beteig 2)months
before March year deduction s sought ND( FV ❑ county Recorder
N COO
See reverse side for additional instructions andq� tti s tBSOr
Applicant(4 nor c«t bu r-cues trLt on reverse sr�e) _ _ 1—
git�istrkt Key I al description //C.�CrI/,--I ��D� Recall number Page number
6 . - at, - 3 -Ib-X00 -00o • `I If 13 1590
sc 0 value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
y 1,crareN year March 1,current year date of application legal or equitable owner?I5S) 60D ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than space,indicate with whom
If name on record is different than that of applicant-indicate below. Is the property in question:Annually Assessed
Cif Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract setter
Address of mortgagee or contact 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 coy,state,and ZIP code)
Drawer NO ao► -3 . nproPe y
Does applicont own property in any other If yes,what county? •
county in Indiana? ❑ Yes ❑ No ❑ No
11'(1 NO.
•
COUNTY,
Deduction approved in the amount of. (58,000. 0°
20_ 20 20 20 I 20 I _ I 20
Signature of County Auditor County Date(month,day,year)
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.
Sig (owner's Ml name) Date(month,day.year)
daI////�yyyy������1l}}}}'I�nb0 n..jS�ibeA-
Fu�re ' entatss of Fnumber a t.qlR state,and L) /'� 1 1 7v(3 9 0 ti
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 -�/, `•_` {•11 -{f Vt Date(moth,day.year)
Address of authorized person (number and street city,state,and ZIP code) .