HomeMy WebLinkAboutMortgage_Marx (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ff'`" i FOR DEDUCTION FROM ASSESSED VALUATION
F' t; State Form 43709(R11/6-09) F I qqN / it
-1 i
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: _
F. ��..
b be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. r 2014
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 twelve(12)months _ 1
before March 31 of each year the deduction is sought • 'v : .:"
GIB
See reverse side for additional instructions and qualifications. • 1 Ty AUD
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...value of real puce„y as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
7. 1,current year Mardi 1,cement year date of application legal or equitable owner?
.e Oen ❑ yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is different than that of applicant.maicat below. Is the property in Ouesdan:Annually Assessed
Lr -_. Property ❑Nw>eIJASSes ed
' Mobile Home(IC 6-tl-7)
Name of mortgagee or contract seller th,e I
/
Address of mortgagee or contact seller(number and street cal:stare.and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city.state,and ZIP code) (j p�� -�
Does applicant own property in any other If yes,what county? What Ta- �� ��). r, . ,D RWc l
•aunty in Indiana? �•�//
❑ yes ❑ No °
COUNTY AUDITOR 1 -. —.
Deduction approved in the amount of. J
20 20 20 20 _ 20_ .
I
Signature of County Auditor • County Date(month,day,year)
I/We certify under the penalty of perjury that the above and fiat-going information is true and correct and that the applicant is a resident of Indiana and
owner II�contrraa()c+tt buyer of the aforementioned property on date application is filed.
t��P")P-4�!!/ /tpp 'o f//(/ofti Date(rtund4 day,year)
Full resident address of a -(narioer aM street dy star and ZIP )
T 0103 )1N1 /II nom `6 2 I,L _ $7657
Person auk by duty executed Power of Amomey or by IC 6-1.1-1 -0.7 Date(rtxWh,day,year)
Address of audxx va.d person (number and street city.stare.and ZIP code)