HomeMy WebLinkAboutMortgage_Miley (2) eY""°4 STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township I Year
Sit FOR DEDUCTION FROM ASSESSED VALUATION DazIar l
l State Form 43709(R11/6-09) GIbr) 2015
i Prescribed by Department of Loral Government Finance vaw 0,41.-1 INSTRUCTIONS: File ark
To be filed in person or oy malt. •
Filing Dates: 1) Real Property:Must be completed and dated in the calendar year for which the deduction is sought r kvEyu :ID.r Must be filed with the County Auditor or County Recorder of the county where the property is located
on or before January 5 of the immediately succeeding calendar year. County--..niter
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the
county where the property is located during the twelve(12)months before March 31 of each year the -
deduction is sought.
•
See reverse side for additional instructions and qualifications. /), .
Applicant(owner or contract buyer-see restrictions on reverse side)
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KeNi n is Ta f`n a I r i G)BSON COUNTY ALn r
Taxing District Key number/legal oesaiption Rexrd number rare di rtr
oaeei4 Ci r ICI — Lg 02-0bl . DO -bo-1 ? C ( '{ 3,s7
Assessed vakie of real property as Mortgage/ tra uaeotedness unpaid as of Mortgage/Contra=indebtedness unpaid as of Is the applicant the sole
March 1,current year Mar=t 1,current year date of application legal or equitable owner?
1 2j 1 %?ADO of 5157).° SI 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
o Real Properly ❑Annually Accessed
Motile Home(IC 5-1.1-7)
Name of mortgagee or con t seller
N. Ve Cie d-+� (�n�oA. .Fit es�oefrm� contra=seDer(number and s:me:,uy,sate.andZ code)lit XI v Acs vC '.en s cda , FL. 325 i 9
Name of assignee or other owner or der of mortgage
Address of assignee(numoer and street.city,stale,and ZIP code)
Does applicant own property in any outer If yes,what county? What Taxing Distna? '"- I
county in Indiana?
❑ Yes ❑ No t
COUNTY AUDITOR Drawer NO am.
Deduction approved in the amount of:
20 20 20 20 20_ Card NO. 37 6 7co
Sgrrattuur'/ee of CC�ountty,A�,udnnor�_ County Date(month,day,year)•
I/We certify under 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 afor mentioned property on date application is filed.
Signal r owne of name Date(month,day,year)
X / / � �l 12q i zit I L1
ru. resident address of applica nu..her and street city,state,and ZIP ) o
%2S N Wes IDY;vt Ca�1 G r N 64--neco6
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(month.day.year)
Address of authorized person (numoer and street.city,state,and ZIP code)