HomeMy WebLinkAboutMortgage_Beghtel y STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R1116-09)
Prescribed by Department of Local Government Finance
Ma
INS7RUC77ONS:
To be filed in person or by marl with the County Auditor or County Recorder of the county where the property is local . road I D
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought ❑ County Auditor
2)Mobile/Manufactured Homes the is sought.Property Must file during the twelve(12)months c E p �rm qRecorder
before March 31 of each 4 3 CO7Y'
See reverse side for additional instructions and qualifications.
Ap (owner or contract t s see .d. °"rererse sLe' ,/ l •
irl(7(irL1_ ' 4/ /�-,)/�-C�- � GIBSn NNyrtY!A�"�
Tp�� Key number I legal description //•��{ Record num- 6c. �r �. ,
N" � el .il - Z/ - yoD - ooi. oi8 -oa7 .orLi L{ (o7
Assessed value teal property of I Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Mardi 1,arrentyear March 1,amen year date of appfi a n... legal or equitable owner?
3 2.0 O ❑ Yes ❑ No
If no,what is his 1 her exact share of interest? If owned with someone other titian spouse,indite 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 contract seller number and street,ay,stall.and LP code)
Name of assignee or other owner or holder of mortgage 7� �c/^,[,/ ('—�1/
Address of assignee(number and street,city.state,and ZIP code) Drawer 1\r O V/l//C 71 Li
Does applicant own property in any other If yes,what county? • What Taxing District? �—f (f ) '7-'
county in Indiana? Card ,r O. l V
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 '/�yy�_,2200��� 20 20 20 20
Signature of County Auditor i�u " ' County Data(month,day:year)
v
I/We certify udder 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 b of the aforementioned property on date application is filed.
Slgriaoi own full cram-) Date(month,day,year)
�, 1(2-3/
FmA I got •• (mum • r.aly state.and ZIP code) ^ L / .•
Pets auuuthorizeddbby duty executed Poem of/Wormy or by IC 6-1.1-12-0.7 I tODate(month,day,year)
Address of auti-xxized person (number and street,city,state,end ZIP code) .