HomeMy WebLinkAboutMortgage_Brogan a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
:,. ._
FOR DEDUCTION FROM ASSESSED VALUATION
I! Stara Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
Fi le Mark
INSTRUCTIONS:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the F
FITmg Dates: 1) Real Property Must file during the b PmPertY located
2) Mobile/Manufactured Homes not assessed as Real deduction is sought County Auditor
before March 31 of each year the deduction is sought�erty Must file during the twelve(12)months sP er
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See reverse side for additional instructions and qualifications.
Apprrtarnl(owrierar�edtra�buJy -see •✓r]• verse sid/ed'1
y11{( !4
Taxing District Key ben/ description
.5:1:!!t�. ,.,,• !\ p�9 �R
- 14.-( g -3D - CI-81Z-007 S
Assessed value of real property as of Mortgage q/rCmo�ant�racts indebtedness unpaid as of Mort gage/Contract indebtedness unpaid as of Is the applicant[ha
March'Lament year March 1, 1 `L r,, _ ^ date of application legal or hose O
�JI lJN✓) Yes
If no,what's 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
5 (3 ❑Real Property ❑Annoy Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,coy,orate,and ZIP code) _ ---- 1
Name of assignee or other owner or holder of mortgage _. — /r. A,1 rJo� .-J
Address of assignee(number and street,city,stale,and ZIP coo Y�V 6 /`
Does applicant own property in any other If yes.wt. •�' 518%.5
cis deduction been requested on property
county in Indiana? rent yearn
❑ No
❑ Yes ❑ Yes ❑ No
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signalize of County Auditor • County Date(month,day,year)
I 1 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. .
re(o IW,pamp) J Date(month,day,year)
F tnare)ss oofofrappifior ym6erydsbeet e. code) (t 4 �Q
Person authorized by duly executed (^Powerr('off Attorney or by IC 6-1.1-12 7 -�,\�'„L Date(month,day year)
Address of authorized person (number and street,city,state,and ZIP code) .
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