HomeMy WebLinkAboutMortgage_Lienemann STATEMENT OF MORTGAGE OR CONTRACT INDEB 1 171_ ty! Township Year
�, FOR DEDUCTION FROM ASSESSED VALUATION
=' � State Form 43709(R11/609)
'1/4<,,- „*"` Prescnbed by Department of Local Government Finance OCT 9 2014
File Marx
INSTRUCTIONS: .
Fonn filed With:
ib be filed in person or by mail with the County Auditor or County Recorder of the county where the Ibro d.
Flfig Dates: f) Real Property:Must file during the year for which the deduction is sought. 1 •Tv A f�ITO 2 2 County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must files allgra twin,, I(!2)montlrs-
be fern March 31 of each year the deduction is sought - ❑ County Recorder
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on side) )
. lear 9`-' #kind ar ia r ?"/112/7 ,
Ta ' stria Key number/legal description Record number Page number
'Y11oY 21 -ii- /7- toga/ 072 IQ J '30/ Q s7-7 3
Assessed va4re d property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact ii&btedness unpaid as of Is the app5rant the sole
March 1:asrent year March 1,current year data of application legal or equitable owner?
d r? 273 7 • ❑ Yes ❑ No
d co,what Is his/her exact share of interest? / If owned with someone other than sparse,Indicate with whom
If name on nxord is deferent than that of appli rant.Indicate below: Is the property in question:Annually Assessed
[Meal Property El Annually Assessed
T Mobile Home(IC 6-1.1-7)
Name of mortgagee or contact seller
� 1
lY
Address of mortgagee or contract sell=er and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and steet,city,state,and ZIP code)
•
Does applicant own property in any other If yes,what county? - What Taring District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes ❑ No ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor • County Date(month,day,)ear)
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 I contract buyer of the aforementioned property on date application is filed.
Signature(o l NO name) Date(month,day,yea
FW resident address adcreaffaurrwyt number aM city,state,and LP
// 4 y S no/ S4` `5 csS A/76 76
Person authorized by duty executed Paver of Attorney arby IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet,dam state,and ZIP code) .