HomeMy WebLinkAboutMortgage_Luttrell STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township 1 Year
c „- FOR DEDUCTION FROM ASSESSED VALUATION I i L D
'1=, State Form 43709(R11/6-09) fl
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: A
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought I 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 - • R V rfi'.'jyi Recorder
GIBSO • .
See reverse side for additional instructions and qualifications.. - - - • . •
Applicant( nor n d buyer-tee on`-�r- side)`
T . DistriG �'/,\[�/Key/ /legal description Record number Page number
,, NQ�a- � aa- lq-ace - 4na - Nem aW- nag ably o.gl1
•
Assessed value of real properly as of Mortgage/Canna indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the
Made 1,current year Mardi 1,cuAent year date of application legal or equitable owner?
I-1 52 bpr) (D'es ❑ No
If no,what is S/her e»share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applIcanl.indicate below. ,e.,l-s-themf�e pew"-__: ion:Annually Assessed
T'v' " - '`r uua 1.1-7)
Name of mortgagee or contract seller
53 �( �........
Address of mortgagee or centred seller(number and sweet,city,state,and ZIP code) _
Name of assignee or other owner or holder of mortgage YA/"t. 51.9...
`C�
Address of assignee(number and street city.state,and ZIP code) .9:A.
Does applicant awn progeny in any other If yes,what county? WI ��l .ma deduction been requested an property .
county in Indiana? rdi�---,,,�rr11��� G� io current year?
❑ Yes (c 9No I Yes ❑ No •
( COUNTY AUDITO
Deduction approved in the amount of
20 20 20 20 20 20 20 .
Signature of County Auditor County 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.
(owner's Ate fb - c I Date(month,day,year)
Full resident address of a • tt(number and 44 city,state,and ZIP code)
Se IIA ► y t_51- Si- { y0co—AaT I 4 J 634
Person audio' duty 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) .