HomeMy WebLinkAboutMortgage_Ellis (4) . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year .
; ; FOR DEDUCTION FROM ASSESSED VALUATION ��
State Form 43709(RI1/6-09)
Prescribed by Department of Lod Government Finance
File Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the properly F' .let n:is located. 2014
Fling Dates: 1) Real Property Must file during the year for which the deduction is sought U County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months „� ,
before March 31 of each year the deduction is sought �, ' F.,,,,•.
See reverse side for additional instructions and qualifier lens. GIB • , r NTY r
/7 , ///��� D/, /j OUNTY AUDITOR
Key her/leg. P number Page ruin
470/e '(- Q 0 /)33— //2- ,9/9 /v �?( V.3
Assessed value real property as of Mortgage/Contra==indebtedness unpaid as of Mortgage indebtedness unpaid as of Is the app&ant the sole
Mardi 1,and year March 1,cement year date of legal or equitable owner?
0 Yes 0 No
If no,what S his/her exact share of interest? If owned with someone other than s use,indicate with whom
If name on record is different than that of applicant.indicate below:
Is the property in question:Annually Assessed
eel Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller Ore ���0 Address of mortgagee or contract seller(nt.city,state, nd ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheer,city,state,and ZIP coda) MO ,r 3 — //o / / /,9(__a
Does applicant own property in any other If yes,what county? What Taxing Distrtri a? O'J( Has this deduction been requested on property .
county in Indianaa? ❑ No ❑ Yes for wrrexu year?
❑ Yes ❑ No -
n I COUNTY AUDITOR
Dedu Drawer NO C-Q1(/g
�(a 93 20 20 20 20
Card NO. 7
Sign County Date(month,day,year)
I/We certify under the penalty of perjury that the aoove anu nor egoing information is true and correct and that the applicant is a resident of Indiana and
ovine I contract buyer of the aforementioned property on date application is filed.
Ni‘" Sig rill d oar &' Date(month,day.year)
yl 1 Full resident address of appp/li ant number and street,aTy,state,and ZIP code) _
1\ S-oR tags; . 0/0r•i s� NA� ler,,3 :L.3 4-7 cowl o
Person authorized by duty executed Power of Attorney or by IC 6.1. -12-0.7 I Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) •