HomeMy WebLinkAboutMortgage_Logestan (2) eg"� . STATEMENT OF MORTGAGE OR CONTRAC IND BTEDNES 1 N County Township Year FOR DEDUCTION FROM ASSESSED VALU O(� LJ b-•' .''State Form 43709(R11/6-09)
Prescribed by Department of Local Government France
OCT 2 3 2014
File Mark
INSTRUC77ONS: - - -- .
To be filed in person or mail with the Court Auditor or County Recorder of the coon milers e. dr Form coed with:
Pe by b ry ty. fit?'pt/h1/4 is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is soit�fjG-JµG�}4i4t�
2)Mobile/Manufactured Homes not assessed as Real Properly M,}{ust Je dying 1W twei a p2Jmonths County Auditor
before March 31 of each year the deductions sought is 1ty, I'r— ❑ County Recorder
See reverse side for additional instructions and qualifications.
Appfrant (�buyfu/�-see nu�rnspn reverse site)_
T
lel
aring D' /% , Key number I legal desaip/�ptnnf�C Record comber Page number
�'� .,?„0.-13 -35/ 06v- m / • -2,35 co �, '&0/41- 3 7 81° .
Assessed value of real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March 1;anentyear March 1,current year date of application legal or equitable owner?
6ifaod ❑ yes El 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&recent than that of appOcant,indicate below; Is the property in question:Annually Assessed
Real Property ❑AmnialN Assessed
Mobile Home(IC 6-1.1-71_
Name of mortgagee or caxlraGrSeNa(
Address of mortgagee or contract seller(number and et,coy state,and ZIP code)
•
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,state,and ZIP code) •.•.' U1^^//
Does applicant own property in any other If yes.what county? • ``�,\ o ...Property
❑ Yes ❑ No V\1 •'• J Yes ❑ No
`O.
COUNTY AUD, \
Deduction C3\
approved In the amount at
20 20 20 20 I 20 20 20
Signature of County Auditor • 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
Amer/contract buyer of the aforementioned property on date application is filed.
'ruse(ov pt Date(month,day,year)
Fu resident address of applicant(number and street,arty,state,and ZIP code)
x el/D7Syo0K 0 44A-Lejf_At9 r4,,. q/746o
Person authorized by duly executed Power of Attorne9 or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sweet,dry,state,and ZIP code) .