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STATEMENT OF MORTGAGE OR CONTRACT INDEBT NN S, �_M1.Mar Township Year
- FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance JUN 2014
File Mark
INSTRUCTIONS:
•To be filed in person or by mail with the Court Auditor or County Recorder of the county where th' ' �,st;!; Font,filed with:
pe v b a ry �Ci7r� .i • rv.
Filing Dates: I) Real Property:Must file during the year for which the deduction is sought. N AA1'DITOR ® County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Me dam$@[f4'jJe,7n�ninS
before March 31 of each year the deduction is sought. - ❑ County Recorder
See reverse side for additional instructions and qualifications.
"�(owner or comma buyer-see on reverse side)
XJ /J�r2�oYf S� QLv a `/YJ .
T ng District Key number/legal description Record number Page number
•
, p r26,-�i -31-300 f0.7. 7 0� ti o7O/ /a 60
P:r.�1,ascent year properly as of Marc 1,current tyye indebtedness unpaid as of Mortgage apt on indebtedness unpaid as of lleegal equitable owner?
aa,-? yOGC) ❑ Yes El No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is afferent than that of app6cant,Indicate below Is the property in question:Annually Assessed
)2 :Real Property ❑Annually Assessed
. Mobile Home(IC 6-1.1-7)
Name of mortgagee con seder
1
Address of mortgagee or contract seller(number and street,ray.state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code)
Does applicant own property in any other If yes,what county? What Taxing District? I for this deduction been requested on property .
county in Indiana? ❑ Yes _
' �1/ r,N,, ��,Ar�^ ,^, //"��1 ❑ No ❑ Yes �❑ No
%frn��r kto ` D —���//y1�(, �2 rS COUNTY AUDITOR /�1 "4n>�
Deductionapproved'uttheamountof-. O Drawer No.. °ZV I :.......
20 20 20 20 C�1ard No. 10�L,0 -
Signature of County Auditor • County ,o„ ilco •••••••••........, —
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the applicant is a resapen.,,...._. and
owner I contract buyer of the aforementioned property on date application is filed.
rs tug name) Date(month,day,year)
�� s �
Full resident address of applicant(number and Ystree4 try, �I��P tco�de) 1 �• (� � I I / 9
‘476/8:i� �c executed i of r n or lflatlf/_l Tad( z-I V Fi' 3 l Date(month,day,year)
Address of authorized person (number and.street,city,state,and ZIP code) .