HomeMy WebLinkAboutMortgage_Williams STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS I County I Township Year
0�``��rrrr'��yy� FOR DEDUCTION FROM ASSESSED VALUATION f
State Form 43709(R111 6-119)
es d
'i9 Prescribed by Department of Lo Government Finance
File Mark
INSTRUCTIONS:
P 1 2 2014
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. Fa n filed
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought 9 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. sought
See reverse side for dional instructions and qualifications �ID30N UU I Y AUDITOR
Applicant(owner or audit buyer-see verse ) - - Record 07 // / 9"/JS t"G� /�5/�/ -
T Key f description I � / ...�J / 7
-/02-02- 0 -000 e30/-- 0,1 Y
Assessed value of real property as of Mortgage/Contract'utdebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Match 1,current year March 1,current year date of application 0 legal or equitable owner?
❑ Yes ❑ No
If no,what is his/her exact share of interest? a owned with someone other than spouse.Indicate with whom
If name on record is different than that of apogean;indicate below: Is the property in ques5wc Annually Assessed
�\ ❑Real Property ❑Mobile Home(SIC 67.1-7)e.Name of mortgagee or contract seller {' )C 1 i`/� S�
Address of mortgagee or contract seller(nrxnberraaidd meet,ray,slat`s,and P code)
Name of assignee or other owner or holder of mortgage /� ///
Address of assignee(number and street city,state,and ZIP code) , / Z �/ ^ -/0 o ��
�jl�/ (TJ j J
Does applicant own property in any other If yes,what county? What Taxing District? I Has this deduction been requested on property .
county in Indiana? Yes ❑ No for current Yew ❑ Yes ❑ No
I�,_ _ __ ___ COUNTY AUDITOR
Q
/1i 20 20_ 20 20 .
Drawer NO...PO ?
Si County Date(month,day,year)
Card NO. 33 1 7 d foregoing information is true and correct and that the applicant is a resident of Indiana and
• .. __._.._..__...._r.,t....iv err eats application is filed.
Signature name) ��/� •
) Date(month,day.year)
//l) 'R.C.L'.l4WW1)J
r Full resident address of 36pricant(number and street city�,/sq/{e,and ZIP code)
c3QIn ) `$that JAepJ ' Lter y /Ai 47670
Person authorized by duly executed Power of Niamey or by IC 6-1.1-12-0.7 Data(month,day,year)
Address of autrpraed person (number and meet city,state,and ZIP code) •