HomeMy WebLinkAboutMortgage_Wells (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count Township Year
"f ;` FOR DEDUCTION FROM ASSESSED VALUATION
1.11 +t . = State Form 43709(R11/609)
Prescribed by Department of ICI Government Finance
File Mark
INSTRUCTIONS:
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To be filed in person w by mail with the County Auditor or County Recorder of the county when the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought. t• �� I` -%•per
GIBSO 1.1x.. .
See reverse side for additional instructions and qualifications. A UDITO R
Appfcant(0- uyer rgfnumber on 5:1e7�
(j`// C/, CJn I�( �
all eGt/ � / Pal d/ / "4 g o/ J3 3 - 6 Record/nigger Pape�l Cid
Assessed value of real property as of 'Vogt/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the ap fipGrant the sole
Meru 1,current year Mammhh 1,current year data of app6cotion �'` legal w equitable ovine?
If no.what's Na/her exact share of interest? If owned with someone other tOu �..C.� ❑ Yes ❑ No
spouse,indicate with whom
If name on record is different than that of applicant indicate beblr Is
property in question:0 Annuayy Assessed
Real Property Annually Assessed
Name of mortgagee or contract seller ��,�QQ {///J f p Mobile Home{IC 6-1.1-7)
L.� �' ZI " '1—!t,
Address of mortgagee or contract seller(n and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage /� Q' 1
^ r iziofigio 7 y
Address of assignee(number and street,cry state,and ZIP code) __
Does applicant own property in any other • I Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes ❑ No Drawer No:.a 1 ' ❑ Yes ❑ No
Deduction approved In the amount of. Card NO. .••I•lY'�+' .
20 20 ' •{ 1.•' 20 20
I I
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.
Signature(owner's full name) Date(month,day,year)
111.tat a 0-1-tas fa
Full resident address of eppint(number and street,oiy state,and ZIP code)
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794a % 4o E /_-1.. i32,,,,,i, NIA/ 47L4P,
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day,year)
Address of authorized person (number and street.city,stata.and ZIP cede) .