HomeMy WebLinkAboutMortgage_Loveless STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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/`y- y ; FOR DEDUCTION FROM ASSESSED VALUATION
�t'_"i}'3.,-J State Form 43709(RU/6-09)
��y�' Presmbed by Department of Local Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county when the property is located. F_ "va: j 2014
Filing Dates: 1) Real Property Must Me during the year for which the deduction is sought El County Auditor
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file during the twelve(12)months
before March 31 of each year the deduction is sought • , 'd `"-
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See reverse side for additional instructions and qualifications. G ' • 1 0 U NTY A 1 I n fl
ApP6cant(owner buyer- ^ w 1`o1.lre1rePf\�f I
T Lstr'vY Key numbei/legal desaiptnn Record number Page number
a1.-. 1 - a '3�z-� aI . iLa col act 7L1-1
Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applrant the sole
March 1,asters year j Mardi 1.wrrent Y�r date of aPPgcation a Ge awnelf
�-13pD es ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with wham
If name on record is different than that of applicant indicate below: property in question:Annually Assessed
fS Property ❑Annually Assessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or t •
Address of mortgagee or contract seller(number and street.city.state,and ZIP code)
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? td on p
county in Indiana?
El Yes teo - / ��/(////\, o
COUNTY A O •' '
Deduction approved in the amount at Y "C[
20 20 20 20 , _ 20
Cara VS).
Signature of County Auditor County Data(month,day,year)
I/We certify under the penalty of perjury that the above and foregoing information is true and correct and that the portant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed. •
Signature(owners AS name) ( ay.Year)
�rp 1210( E. to255_ Qca lard, C.i.trza 4Zlolao $.'.1 `-/e .-
Fu4resident ooT�ppGgnt(number and street,city,state,and ZIP code) '
frson aut orizedd yLtycel>�wted Power of Attorney or by IC 6-1.1-12-0.7 Data(month,day,Yeas)
Address of authorized person (number and street ray:state,and ZIP code) .