Mortgage_Higginson a. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
iii,.. ..:tal FOR DEDUCTION FROM ASSESSED VALUATt
State Form 43709(R1116-09) Finance
Prescribed by Department of Local Government k U {
File Mark
INSTRUCTIONS:
To be tiled in person or by mail with the County Auditor or County Recorder of the countynt here the pry-Reify is located. Form fled with:
Filing Dates: I) Real Property.Must file during the year for which the deduction is sought. N County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property.Must De during the twelve(12)months County Recorder
before March 31 of each year the deduction is sought ./l/ b
See reverse side for additional instructions and qualifications./1 / (/,�( 'II'"GII B SONN Cj/QUO U1J/�T/Y'�A(i n,r�..
Appfrant(oV or contract buyer'sorb'`�y(llxr. t Q. I l I/ �N�✓Y�
T District f Key /legal dewiption U Page number
6-aa -o�aoo-oc B S-bcx' i 33 7(0
Assessed value of real property as of Mortgage 1 Contract indebtedness unpaid as of Mortgage l Contact indebtedness unpaid as of Is the apparent the sole
Mash 1;amn/year =aim amem year date of aPPf�t'v, legal a equitable owner
14500 o ❑ 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 deferent than that of appfcard,indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller / ` ' I �.vlf Q ' '^
Address of mortgagee or contact seller(number and street,ccity^�'i&aIte,and ZIP codes)),/' 1/.1/~�f11L
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested an property
county N Indiana? ❑ yes ❑ No moment year? ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of: -
20_ 20 20 20 20 20 20
ty ✓l.� LA—ht County Date(month,day,year)
I/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. .
Signature fill name) Date(month,day,year)
/ 'r
Full esident address•/.poricant n 4 bera al,state,and LP code)
`DO .S"AG . 9m' ore. th .ai•lt .4‘... 47439
Prson authorized by duly executed Pow of Attorney or by IC 6-1.1-12-0.7 / Date(math,day,year)
Address of authorized person (number and sheet,city,state,and ZIP code) .