HomeMy WebLinkAboutMortgage_Koonce III F.aM. FOR DEDUCTION T IO F MORTGAGE ES OR CONTRACT INDEBTEDNESS 7111:/crilt) Year w FOR DEDUCTION FROM ASSESSED VALUATION
1' State Forth 43709(R11/6-09)
Prescribed by Department of Lod Government Finance
File Mark
INSTRUCTIONS: M A I i eon
To be filed in person or by mail with the CountyAUditor or County Recorder of the county where the properly is located.
Filing Dates: 1) Real Property Must Me during the year for which the deduction is sought. . 111 •, , •-•
2) Mobile I Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought I,it CISMiS'- "•
See reverse side for additional instructions and qualifications. GIBBON IT•I�t: _ e :•
(owner or contract buyer-see on re e)
- �
Taff Istria Key number/legal desciption Record number Page numbes
A a 6_�,l 07 - oZ of - 003. 7 5c(-0,1e ?- ) .../(
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage l Contrast indebtedness unpaid as of is the applcent the sole
Mali 1,axrent year March 1,current year date of appllcatin legal or equitade owner?
317 pp O ❑ Yes El No
If no,what is his l her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of apptaant.indicate below Is the property in Question:Annually Assessed
❑Real Property ❑Annually Assessed
- Mobile Home QC 6x1.1-7)
Name of mortgagee or contract seller /I I
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" jgnee(number and street 73 ode) _ _ -
Does applicant own property in any other If yes,what county? • What Taxing Distil
county in Indiana? f
❑ yes ❑ No Drawer NO.. . o f� ....
COUNTY AUDITOR ^
Deduction approved in the amount of: Card )N O. ... .. .... -
20 20 20 20 2u
1
Signe of County Audi?), • County Date(month,day,year)
I/We certify under the penal`/tyVoffpperjury 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 date application is filed.
(owner's full name Date(month,day,year)
k h�utaddress rr ��,,,�at .
'� Full resident address of applicant number and street state,and ZIP code)
`N9 C. 0Ale sA-S mill ctt4nn , ry . 9774
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(math,day,year)
Address of authorized person (number and street cry,state,and ZIP code)