HomeMy WebLinkAboutMortgage_Lieneman a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County f0 ' Dr
�._.,._
�� ; FOR DEDUCTION FROM ASSESSED VALUATION
State Forrmt 43709(R11 DEDUCTION)FROM
'1/4'..111111111;111011. Prescribed by Department of Local Government Finance
Re Mark
INSTRUCTIONS: Co I •F. red with: '
b 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 Pmpedy:Must file during the year for which the deduction is sought County 'tm�
2) Mobile/Manufactured Homes not accessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - �
See retie 'side for additional instructions
Record rum P ge mnnlw
)&7 / - / 3/ de-O0co f' Oat/ lo /.5 ���
Assessed w of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Conaact indebtedness unpaid as of Is the applicant the sole
March 1, year March 1,anent 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 wham
If name on record is different than that of applicant,Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑AnnualyAssessed
Mobile home(IC 6-1.1-7)
Name of mortgagee or contract seller
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) 2
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?No
❑ Yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of. -_ -
20 20
t_. EP MAru ) D4� S
20 20
Signature of County Auditor /3— i(7/(/ Date(month,day,year)
I/We certify under the penalty of perjury tit: / 7 at the applicant is a resident of Indiana and
owner I contract buyer of the aforementione
X "gnaw vmeas nam —I Date(month,day,year)
r ie/(n m/y�i0/H��)
Ft t ' ap t(number and street a1y,state,and ZIP code)
I 1 ID//o £.. boon LJ 01,04°7va■ &# , �f7(49S
Person authorized by duly executed Power of Atturn..y 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) •