HomeMy WebLinkAboutMortgage_Brickey _.'���. _ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County IFTL F'
ri FOR DEDUCTION FROM ASSESSED VALUATION
' State Form 43709(R71/609) I
Prescribed by Department of Local Government Finance
Fil- `I- I I
INSTRUCTIONS:
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located Forth with:t.
d.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought p' Caun,Au•d.,•
2) Mobile/Manufactured Homes not assessed as Real Property:Must hle during the twelve(12)months iw+ • •••-4110
before before March 31 of each year the deduction is sought - G I S• • C 0 N Y A • •
See reverse side for--•• .:I instructions and qualifications. Ls
Applicant(owner. -see on reverse side)
Taxirg D' Key number/ al description �--� Record cumber Page number
Zc. -iv l - oa�-ao1 l`k 5..S I
Assessed value of real property as of Mortgage/Conbaa indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,anent year March 1,current year date of application legal or equitable Owner?
(a 9 0 0 a fttt(es 911,
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 different than that of applicant,indicate below: fq'�t'Ih� es
e property in question:Annually Assessed
'-*h""I Property ❑Annually Assessed
/// Mobile Home(IC 6-1.1-7)
of rtrorigagea seller
Add of mortgagee or contract seller(number and street,city,stare.and ZIP code)
Name of assignee or other owner or holder of mortgage_ __
Address of assignee(number and street,city,state,and
Dl a ll'Cr NO. l/7/� this deduction been requested Does applicant own property in any other Q..7.., property
county in Indiana? ❑ Yes ❑ No this year? ❑ Yes ❑ No
Card NO. QSs1
Deduction approved in the amount of. •.••••..•.• ..•. .
20 20 20 l 20 I -- 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 contract buyer of the aforementioned property on date application is filed.
SIgnaaue(o (B name) Date(month,day,year)
resit t yr off vappGgdl(number and street, std and ZIP code)
208 5• west •`Fret Oa+<lavid City, tW '7&tot)
Person authorized by duty executed Power of Attorney or/by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street oily,state,and ZIP code) •