HomeMy WebLinkAboutMortgage_Michel (9) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ki, FOR DEDUCTION FROM ASSESSED VALUUATION State Form by 03709
Dep R11/6-09) FILED Prate for by 709(RUent of Lod Government Finance
File Mark
INSTRUCTIONS: 1
To be filed in person or by mail with the County Auditor or County Recorder of thetpib' typ?r4rr.�$4roperiy is located. Form filed
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. IC 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 a ❑ County Recorder
See reverse side for additional instructions and qurallifications. �Igs�p COUtiT�D np
Apprcanl(min bu r�' I ea(��{{ f��/h -�-/�./
T Strict KaY /171 / oo-ooa-3-7a-o� ati Page number
Assessed vatue of real peppery as of Mortgage/Contrary eq�dddness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the appal the sole
March 1.anent year Mardi 1,anent 7 O� date of aPP�ton legal o�Yes O
Yes No
If no,what Is his I her exact share of interest? ( if owned with someone other than spouse,Indicate with whom
It name on rend is different than that of appacam,indicate below. Is the property in question:Annuaey Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seder (� _l CM
Address of mortgagee or contract saner(n street.city,state,and ZIP coddee)
Name of assignee or other owner or holder of mortgage
•
Address of assignee(number and street coy state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District?. "—
ring en requested on property
county in Indiana? ❑ Yes ❑ No __
❑ Yes ❑ No
Deduction approved in the amount of: 1 ....
Draw cr 20 20 20 1(p 1.3..:.......• 20
Card gip. ... op
o
Signature of Canty Auditor • 416/ 6/, ')ear)
I/We certify under the penalty of perjury that the above and foregoi ,.urrect and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date applit. ......med.
r(owneh name - / Date(month day,year)
ent address of app/an,t(nun r and street cry,state,and ZIP code) r C L/GOLF LF s d-e twit I6 f'f' for"-f7 Bran tik L/11 q76/4 ft
Person authored by duty executed Power of Attorney or by IC 6-1.1-12-0.7 f Date(month,day,year)
Address of authorized person (number and sheet city,state,and ZIP code)