HomeMy WebLinkAboutMortgage_Jones (19) STATEMENT OF MORTGAGE OR CONTRACgE TE County Township Year
to/1"'` ���FFF 000111��-; FOR DEDUCTION FROM ASSESSED VALU i State Fanrn 43709(R71/6-09)
Prescribed by Department of Local Government Finance JUN 17 2014
File Mark
INSTRUCTIONS:
•b be filed in person or by mail with the County Auditor or County Recorder of the co . t.i.-:7 j,,T•('r:-14, is located. Form coed aim:
Filing Dates: 1) Real Property Must file during the year for which the deduction is so• t. Y AUDITOR County Auditor
2) Mobile/Manufactured Homes not assessed as Real Proper bra • nnme fWenre(1
months
before March 31 of each year the deduction is sought - County Recorder
See reverse side for additional instructions and qualifications.
Apgarant or contract uye!yQee Con rreevve�rsee sside)
T ' trict J/l Key num I legal description Record number Page/
AIM0.0k ) a10-la-Q7-'S/O -00 • 90 s ciaRI act/3
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Concoct indebtedness unpaid as of Is the applicant the sole
March 1.amen year March 1.current year date of application legal or equitable owner?
/50CC ❑ 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 dfFerent than that of applicant,indicate bebvr. Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract ler /�
(number and s/
Address of mortgagee or contract seller(number and street,city,state.and ZIP code) _
•
. i
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city state,and ZIP code) D 1715'C I' NO .N
Does ain Icon own property in any other If Yes,what county? W Card �'O. ....3 91� ❑ No
county in Indiana? ❑ Yes ❑ No //��„,,, -
COUNTY Aut,.._- 4/` /COO bbl .••..
Deduction approved in the amount of:
•
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/contract buyer of the aforementioned property on date application is filed.
Signature NN me)1
p.4._
(�� T 'J /_ Date(month,day,year)
�^den re of a a (�c\�r te{7�i�'feJ Y / l5J 70 �r�l /�Y
!P authored by duly executed Power of Attorney or by IC 6-1.1-12-0.7 , Date(month,day,year)
Address of authorized person (number and street.ckt state,and ZIP code) .