HomeMy WebLinkAboutMortgage_Stout (2) 14 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year -
, FOR DEDUCTION FROM ASSESSED VALUATION
State Farts 43709(R11/6-09) T eryg ®`'��
Prescribed by Department of Lad Government Rnance p 0 r C Il.
File ALA
INSTRUCTIONS: (modhq
Pe by County county property Form JU)V 1 6 2014
To be filed in person or mail with the County or Court Recorder of the court where the m is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12)months �,1
before March 31 of each year the deduction is sought - LJ/ Court R e
a Bf
See reverse side for additional instructions and qualifications. G I BSON Cal 1 N
Appfcan owner or convectt.buyer�-see on reverse
/ Record number Page number
_�vv/yy��t�/+I�/ o� e- /l -/s- tot- op/. 9 f- o ' do( a4
Assessed value of real property as o/ Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appliscant the sole
Math 1,truant year March 1,current year ,
r date of application legal or equitable owner?
f 30 OCJs ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,Indicate with whom
If name on resod is different than that of appOcant indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract ra seller ,A
Address of mortgagee or contract seller(number and street city,state.and ZIP code)
Name of assignee or other owner or holder of mortgage n
Address of assignee(number and street city,state,and ZIP cane) Drawer S;-pca/' 0...K f d6 —- --
Does applicant own property in any other If yes,what county? • What Tadrp L I a}}'})'e 1- `i O —
county inlndana? ❑ Yes ❑ No aO/4lGt9oQa41G...r— 1
Cali.] NO.
COUNTY AUDITOR t30, O t 00 .-
Dedwson approved in the amount oh
20 20 20 20 20 20 20
Signature County Auditor / •% County Date(month,day,year)
I 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 contract buyer of the aforementioned property on date application is filed.
)c***'Sigcawre(o. :) Date(month,day,year)
\ �., �- of eZ t(n SMAnxr eY and 71 code Li -y•
Person autar¢ed by duly executed Power of or by IC 6-1.1-12-0.7 ' Date(month,day,year)
Address of authorized person (number and scree{city,state,and ZIP code) .