HomeMy WebLinkAboutMortgage_Grubb f.a v- STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
; �: FOR DEDUCTION FROM ASSESSED VALUATION
t= State Form 43709(R11/6-09)
Prescribed by Department of Local Government Firarce FILED
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the prope r located. Form filed
Filing Dates: f) Real Property Must file during the year for which the deduction is sought.MAY 0 9 2914 14 4 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file dunng the twelve(12)months
before March 31 of each year the deduction is sought County Recorder
See reverse sid" additional instructions and q a cations.
ApprEant(' l l I r. ,SON COUNTY AUDITOR
Key number/legal description Record T J
;II I &Z6-/ 7-0/-0100-003. 936-oar met
- ..value ci I property ge/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1,current Ma �ntt date of application legal or equitable owner?
If no,what is his/her exact share of interest? �y ��� If owned with someone other than spouse,indicate with whom ❑ Yes ❑ No
If name on record is different than that of applicant.indicate below: Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
. Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street city,state,and ZIP code)
Name of assignee or other owner or hr G 2 u R J, [
=s w47- tom
Address of assignee(number and stre nI 7 - ,4 A
Dees applicant own properly in any o �"�-t/ r�"{� �-_1 /t net? Has this deduction been requested on property
ovnly in Indiana? ❑ Yes /U -1 /��J for curtest year? ❑ Yes
❑ No
Deduction approved in the amount of
20 20 20 20 20 20 20
•
Sgns . of,l i / 1'�i1 r r l.11/ `. 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.
`+SSiiig (owner's a Yf '� Date(month,day.year)
/Full resd /nt address of applicant(number and street city,state and LP �, _ /� n ^ 1 /
CO lV tD(n 5 W F u--t 7L n n-r 1 e " t� -mil T I J 41 6 to
Person authorized by duly executed Power of At or IM IC 1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and LP code)