HomeMy WebLinkAboutMortgage_Roberts (5) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun ;v:E ri""��1 t r
w -�:,: FOR DEDUCTION FROM ASSESSED VALUATION it .i
'."' 'r- State Form 43709(R11/6-09) i
Prescribed by Department of Local Government Finance /�p�,,�yrq
INSTRUCTIONS: ~f"n'-r"V 2014
To be filed in person or by mail with the Cou Auditor or County Recorder of the county where the Form fly "
pe y my ry ry property is located.
Fling Dates: 1) Real Property Must Me during the year for which the deduction is sought.
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)month; Vr'm'ir
before March 31 of each year the deduction is sought I BS U N Iglu ^ • . ------
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See reverse side for additional instructions and qualifications.
Appf t(Opy o mn� y'er-see Ltoictionsonreverse sideIj ``
'faxing- District fi��rn\uCmb / 2p•� t— Record number Page number
O t L .- L( - n . l •� ( . S nit-rte ( o1Li 1597
value of dal prapery as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the apf�t the sole
1,asrvrt Y� March 1,current year data of appfxation legal or equitable owner?
g D O.6 Yes ❑ No
If no,what is his/her exact share of interest? If awned with someone other than spouse,indicate with wfiom
If name on record is different than that of apptcant.indicate below. Is the property in question:Annually Assessed
?ea!Property ❑AnnualyAssessed
• Mobile Home(IC 6-1.1-7)
Name am �f mortgagee a contract seller
ACdre&s of mortgagee or contract seller(number and street city,state,and ZIP coda)
Name of assignee or other owner or holder of mortgage '---___
Address of assignee(number and street city state,and ZIP code) -
Drawer NO...?O19
Does applicant own property in any other If yes,what county? - shed on property
county in Indiana?
El yes ❑ No 1 /67.7 � . . Yes El No
•
Card NO. T/
COUNT
Deduction approved in the amount of:
20 20 20 20 h - 20
Signature of County Auditor - 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 I contract buyer of the aforementioned property on,d���///a��tte application is filed.
dire L-RS l)�A Si,S Date(month,day,year)
F resident of appecant(number and[m�eet.try,state,and code)
`P '-f49 ' IaC S Arlr..eaCrn f u 4'1 10.10
he�a authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of autmd[ed person (number and meet,city,state,and ZIP code)