HomeMy WebLinkAboutMortgage_Moog (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court j�j;�jjj�i�!i .j.
A'�- FOR DEDUCTION FROM ASSESSED VALUATION '
Cis
State Form 43709(R11/6-09)
Prescribed ^^—esPrescribed bee by Department of Loral Government Finance ) i 7 ./
F1M.l art 6 014
INSTRUCTIONS: .
Form ed with:
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. . ty,_ :tor
2) Mobile/Manufactured Homes not assessed as Real Property Must hle during the twelve(12)months GIB 80 too pj.
before March 31 of each year the deduction is sought RFO R
See reverse side for additional instructions and qualifications.
App
or contract side
/ �� �� Record _Diet T f iL�rof--�/ Ill 1,1-/e J a1 D�7 Jaw
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Assessed value of reel property as of ortgage/ -et indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Ie the appluant the sole
Mardi t ormntyear aarrchr=Tat/ year date of apt s.�rvy���� legal ar equitable mnrlt
v j ul.JG O ❑ Yes ❑ No
If no what Is his I her exact share of interest? If owned with someone other than spouse,indicate with whom
If name on record is CRerent than that of applicant,Indicate below. Is th property in question:Annually Assessed
Real Property ❑Annually Assessed
• Mobile Home pC 6-1.1-7)
Name of mortgagee or contract saer /
Address of mortgagee or contrail seller(n and street,ray. nil ZI code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number end street m):state,and ZIP cede)
. Does applicant own property in any other If yes,what county? . What Taxing District? Has this deduction been requested an property
county in Indiana? r
for cut year?❑ Yes ❑ No ❑ Yes ❑ No
/o(/,t A. mO O (
COUNTY AUDITOR
6 —6_3 iii,
Drawer NO y —a 3f l
/7fit--)t e LT/at • a — 20 20 20 20
Card NQ.#..e /
000 • CO County Date(mmm,day,year)
I I We certify under the penalty of perjury that the aoove and foregoing information is true and correct and that the applicant is a resident of Indiana and
Amer I contract buyer of the aforementioned property on date application is filed.
,//� re(awnefs full i) Date(month,day,year)
A(n ' Yom^
Full resident t(number and street,thy, to,and z74I.R22.�)��mdde ^��,\
rQ)��I /A t n , . f)i nce�con �Lv V �') L-7 0
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(north,day,year)
Address of authorized person (number and street dry state and ZIP code)