HomeMy WebLinkAboutMortgage_Heavrin M� . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year ,
FOR DEDUCTION FROM ASSESSED VALUATION
••.:,.. -1- State Form 43709(R1116-09) FILE
Prescribed by Department of Loral Government Faarxe
INSTRUCTIONS: Wtrl t wN�, ,f
To be filed in person or by mail with the County Auditor or County Recorder of the county when:the property is located. I I N { [Q1Y
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought IL'JY County Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file during the twelve(12)months ❑
before March 31 of each year the deduction is sought - ou er
See reverse side for add';nal instructions and qualifications.,
Taxing District ^a _IKeano3 _ goo- �.o. 2 , /-oa� o2 Onu0 Pagensz "O
Assessed value of real property of Mortgage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year Mardi 1,current year date of application legal or equitable owner?
I 90f DU?� ❑ Yes ❑ No
If no,what is his I her exact share of interest? if owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant.indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name at mortgagee cv ' tract seller n ,. ty /_ 1
'p(`('J�l J\J�-�/1, •It, vL'-.[•.'(rj/J""te,,.a4J` 4..QIwV an-,
Address of mortgagee or contract seller(number and street city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage --��_ L
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If Drawer No, /�
Y yes,what county? What Taxing District? .....••.••........
county in Indiana?
❑ Yes ❑ No -
Card NO 034/6
COUNTY AUDITOR [y'ha' i/ i '•••
Deduction approved in the amount of. �' ""•'n Ova/Niue-Ls,
20 20 20 20 20 20 20
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 I•• tract• i - •f the aforementioned property on date application is filed.
Signature f 1. /) Date(nwtdt day.year)
F - .... -�of aoolG/�caT�n't(number and
�� ssstmet,t(•f�'']/y,sate,and ZIP coydfe) (�y
/._. by duty /l oAttort�eyonM Eetb i�1 , z/96 9a Date(month,day,y _ - -
• — of autha¢ed person (number and sheet city,sate,and ZIP code) .