HomeMy WebLinkAboutMortgage_Brown (20) STATEMENT OF MORTGAGE OR CONTRACT INDEBT Township Year
a!^.i;fir FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/r,-0g)
Prescribed by Department of Local Government France
JUL 2 3 2014 File Mark
INSTRUCTIONS: F filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is tea
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 Property Must file during the COUNTY AUDY( County Recorder
before March 31 of each year the deduction is sought. G(BSON
See reverse side for additional instructions and qualifications.
AppEcan caner or contract buyer-s e restrictions on reverse side)
Ta 0' a Key number/legal desaipticn Record number Page number
10- 14 -IY, - o 1 -00G `iv-1 •9 007 14 -aaa-7
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Cars iddebtedinews unpaid as of Is the applicant the sole
Marts 1,current year March I wren date of application legal or equitable owner?
5 4 0 Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than strive,indicate with whom
If name on record is different than that of applicant indicate below: Is the property in question:Annually Assessed
'seal Property ❑Annually Assessed ss E1.1-T)
Name of�/ na9e^e or contrast seller
'�/"
1 I cage o contra `
Address of mortgagee or contract seller(number and street,city,state-and ZIP code)
u ^_^ Vic)Name of assignee or other owner or holder of mortgage � l�yT" ,"-
Address of assignee(number and streets city,state,and VP code) O-,,r I. -•..
Drawer t
Does applicant own property In any other If yes,what county? L - --- (�1 0 RA- W
sratY .
county in Indiana? ❑ Yes ❑ No I. NC). t.t-...t......... ❑ No _.
Card 81 c� � 4 .o 0
COUNTYP
Deduction approved in the annum 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 1 contract buyer of the affoo�ree^m/en^tioned property on date application is filed.
Tad; (n name) ' r / . . Date(month,day,year)
F/\f^(/ �(�� \e��f/� �,, �� �y
ill resident of t(number and street,city,state,and ZIPPcco�de))� ///� U (/n�/�
Person authorized�y duly executed uo—eymcbylCG1.1-11 AY- --C.IJr� l?rl(s ) `-7 "0O (month,daY.Y��Date
Address of authorized person (number and street,city,state,and ZIP code) V.1