HomeMy WebLinkAboutMortgage_Dasch • E,a.�. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/5- )
Prescribed by Department of Local Government Finance
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INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property Form Aed with:
Pe Y tY h tY P PertY is located. r l�Meyl1 ,t�
Filing Dates: f) Real Property:Must file during the year for which the deduction is sought. MAR 3 1 [70l4"oun Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months b
before March 3i of each year the deduction is sought. - ❑ County Recorder
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See reverse side for additional instructions and qualifications. NJ AP
Applicant(owner buyer-see reverse GIBSON°/COUNTY UDITOR
Tab - ,,✓''1..�/e- Key number/legal description Record number Page number
et ?4 - ii- /2- /oY - coo . 533 - o .. 8 do/f /S/
Assessed vahre of real property as of Mort gage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year March 1,current year date of application legal or equitable owner?
2 S 0 0 0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? 1 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 ❑Annually Assessed
Mobile Home(IC 51.1-7)
Name of mortgagee or contract seller 1.3
Address of mortgagee or contract 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 state.and ZIP code) Drawer 1\r O 4.0/
et.... _.
�J ,/�. / ia • 33 / 3yPT •
Does applicant own property in any ott If yes,what county? WI /_/'`�) / h
openly in Indiana? ❑ No Card NO• / }�f J ❑ No
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❑ Yes
P
COUNTY Al ..
Deduction approved in the amount of I I
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20 20 20 20 20 20_ 20
Signs o County Auditor , /_p County Date(month,day.year)
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 prope on date application is filed.
�/ SigreNm rs fiA me) Date(rrorWr,day,year)
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Full resident address of applicant number and street,sty,state, LP
'1/ /ea) U,/. 31--t.-., f% e r to /1/
Person 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 dory,state,and ZIP code) -