HomeMy WebLinkAboutMortgage_Aregood Alrizt STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
' FOR DEDUCTION FROM ASSESSED VALUAT�
State Form 43709 De arts L 6-09)
V Prescribed by Department of Lod Government Finance
LEI)
Re Mark
INSTRUCTIONS: qqQ
To be filed in person or by mail with the County Auditor or County Recorder of the t ibhkfe�O property is located. F coed wife
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 e Burin th (12)months
before March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications COUNTY
AUDITOR
..,oC(1N GO
pan�(ownerorwri06uyar-fee on reve side)
col[/A/d///J`'Kn/r'y'y'uJ�6^d p/�• 4)Jz�
T Disukt Key /legal description Record number Page number
Z(0-ov -2LI-3oq ,1K) o/9 a0 14 3_(r9.53
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
Mardi 1,current year Manic 1.cement year date of application legal or equitable owner?
❑ 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-Indicate below Is the property in question Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller �//� _ _
Address of mortgagee or panted seller(number al Drawer 1\i 0 �-{0
Name of assignee or other owner or holder of moat
Card NO.
Address of assignee(number and street,ray,stare, -n � � n0
. C�ai"'uL Qltoocia��
Does applicant own property in any other _ LJ Has this deduction been requested on property .
county in Imiata? ❑ Yes ❑ No I for current r? ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount at
20_ 20 20_ 1 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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/contract buyer of the aforementioned property on date application is filed.
Signat/ur/e�owirers f�r�am�) Date(month,day,year)
FY"//�} :d a t(pQAW, and sheer./.state. ZIP code)
//�/`/r/�//y////��^n/j�/ Gr u' state, AL /7)a 4, . ; 6v/7 itht, /X/ (/7
`�'aswn ut(wraed by d execited i�Attorney or by IC 6-1.1-12-0.7 Date(month.day,Year)
Address of authorized person (number and street,ray.state.end ZIP code) .