HomeMy WebLinkAboutMortgage_Miller (38) STATEMENT OF MORTGAGE OR CONTRACT IND T DE Ito, 1y Township I Year
f' FOR DEDUCTION FROM ASSESSED VALUATIO
.. 'tom j'. State Form 43709(R11/6.09)
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Prescribed by Department of local Government Finance
2014 File Mark
INSTRUCTIONS: JUL 3
Fain fled with:
Fs be filed in person or by mail with the County Auditor or County Recorder of the county where the property is h,�.. -•.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought n ik County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file du•-7/.., • .•od11!•t •before March 31 of each year the deduction is sought. COUNTY A -* OR ❑ County Recorder
GIBSON
See reverse side for additional instructions and qualifications. .
Applicant owner -contract buyer-see restrictions on reverse side) „
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T District I Key number/legal description Record^ Page number
it%NC.2t01'n ? (0- \2-\-1 -1o3- on ti . z4 5 -0D ! `i o285q-
Assessed value of real props y as of Mortgage/Contact indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of is the apse:ant the sole
March 1,axrad year March 1,anent year date of application legal or equitable owner?
5'O2 ❑ Yes ❑ No
If no,what is his/her exact share of interest? CO �2 If owned with someone other than mama,indicate with whom
If name on record is different than that of applicant,indicate below- Is the property in question:Annually Assessed
fig Real Property ❑Annually Assessed
. Mobile Hone(IC 61.1-7)
Name of mortgagee tract seller rvg
Address of mortgagee or contract r(number and street a -
Name of assignee or other owner or holder of mortgage �� Mir^/1 //
•
Address of assignee(number and street my:state,and LP o Drawer 1\O `'l,..K----/rrr���,''�))J,..... I
Does applicant own property in any other If yes, 1 � � is this deduction been requested on property .
musty in Indiana? ❑ Yes ❑ No Card \O: 111---/// r current yeah ❑ Yes ❑ No
UVUN 1'r"NUUI I UN-
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of Corny Auditor • Canty 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.
fir rs tuff )%?tsueet Date(month,day,year)
d—/Full ofEpWc a7y.state,aM.Ay code) 7/ /�
Person uthorized 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,city,state,and ZIP code)