HomeMy WebLinkAboutMortgage_Snyder 7 n4 STATEMENT OF MORTGAGE OR CONTRACT tJ I County Township Year
t FOR DEDUCTION FROM ASSESSED VALU p-I
State Form 43709(R11/6-09) L
1 Prescribed by Department of Local Government Finance
JUL 1 File Mark
INSTRUCTIONS: ` 15 Z�14
To be filed in person or by mail. Form filed with:
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year f hick th dads Lion is sought.
Must be filed with the County Auditor or County Recordefrp//t�he is located ❑ County Auditor
on or before January 5 of the immediately succeeding caT2Fldir drC 0 11th El County Recorder
2)Mobile/Manufactured Homes not assessed as Real Property:Must Rew7th'thidl idorit�f� r of the
county where the property is located during the twelve(12)months before March 31 of eacn1Year the
deduction is sought.
See reverse side for additional instructions and qualifications.
Ap icani(owner or contract buyer-see restrictions on reverse side)
Yaa 1,t. - Si'L GLP1i• + J and
Ta " g Disi{ict Key num l/legal description Record number Pita a number
a tc �� a 9-D5-31-0-00-cOo,� -calla nZ 31 I /C' &'oI �t9/
Accessed value of real property as of Mortgage/Contract indebtedness unpaid as of M rtgage/Contract indebtedness unpaid as of Is the applicant the e
March 1.current year /� dip) March 1.current year date of applica/ti�t"oo�n� ���/f"11.,-,, legal or equitable owner?
I-I / iW I r O CALL) aPas ❑ No
If no.what is his/her exavtt share of interest? If owned with someone other�n spouse,indicate with whom
If name on record is different than that of applicant.indicate below: �Iss theep�`operty in question:Annually Assessed
+{Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Named of mortgagee or contract seller .
H21r•I e �..cL nu( CrecCt�' LL{'usn'yv
Address of mortgage contract seller(numb ands city.Mote.and ZIP code)
5388 0 Of e- � o Gi 67 iCeuJi_o crs1- TV y7(o30
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? Has this deduction been requested on property
county in Indiana? '' // for current year?
❑ Yes 040 ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20_ 20 20 20
Signature cf County Auditor County I 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 applicati n is filed.
azure s full na 1 Date(month.d g year)
Full adobes ^ iranl num n ree s te.and ZIP code) /armnc^ ) 47670
Person authorized by duly executed Power of Attorney or by IC 64.1-12 �-/ llL I Date(month.day,year)
Address of authorized person (number and street,city,state,and ZIP code) 11
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