HomeMy WebLinkAboutMortgage_Lamey 1:+ . STATEMENT OF MORTGAGE OR CONTRACT IND T�D ounty Township Year
'Sol, FOR DEDUCTION FROM ASSESSED VALUATI 1 r�.J
1i State Form 43709(R11/6-09) g,,
Presaibed by Department of Local Government Finance
INSTRUCTIONS: APR
3 n 14 File Mark
with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the prope it,,. •anted. Form filed
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought • ana, County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file •2;,.y•.r- ':!: •
before March 31 of each year the deduction is sought - TY County Recorder
See reverse side for additional instructions and qualifications.
(,(BSON COUN
Applicant(owner or buyer-see restriction on reverse side)
5 am
Record District efF)-� y number/legal description Re number Page number
W7lloryt_ a) 4,-19-19- Zoo-cco x( 97 -0%5 ao/41 //(ol
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,current year date of application legal or equitable owner?
(.05 000 ❑ Yes El No
H 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
9gceal Property ❑Annually Assessed
/ _ Mobile Home(IC 6-1.1-7)
Name of egee or contract setler
trot-/n�AX.C1 A,C� 1 „itg 1..)\
Address of mortgagee or contract seller(number and sheet 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 If yes,what county?_ , _ What Taxing District? Has this deduction been requested on property
county in Indiana? n v� n •, I - for current year? ❑ Yes
i� ❑ No
Dra\\`C'r Ng..ShvI "'•.• .• fY AUDITOR
Deduction apprw
Card NO. .... . ............
20 20 20 20
OD
Signature of Count AI lX 5 `�• • 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.
Signal (oncosts tub name) 4 , / � Date(month,day,year)
Full 'dent ress of applicant(number and sheet,city,state,and ZIP code)
. 5; 7r 7505 Foe/ 4tc-vc1 , .tau /7G f7
authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) .