HomeMy WebLinkAboutMortgage_Chatmon a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09) `{ , I R J
Presaibed by Department of Local Goverment Finance Ii. 9 tin
File Mark
INSTRUCI7ONS: OCT 3 0 7014 Farm Red with:
7o be filed in person or by mad with the County Auditor or County Recorder of the county where a property is located.
Filing Dates: 1) Real Property:Must rile during the year for which the deduction is sought Ifr County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Mar file during the.twelve-(12)months ❑ Recorder
before March 31 of each year the deduction is sought )(41;/ter j{u4y ,
See reverse side for-•ntionalins ins a.. .ualificat'.s. ( /�'GIIJBSS]ONC�OUNTYAUDITOR
ApPficant(awrnr.4 '.tr. '..�� 1 �e) \J� /�/�.I / • /0q-it Fteaud Key
oo Pa�f T ,�l/N1 -147-100 -(-)no .301-c oc, "r3
Assessed value of real property as of e/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the appfrant the sole
March 1:one year Mamli t.amen date of application legal or equitable owner?
qa0O00 • ❑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 drfenent than that of apseora,indicate below. Is the properly in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobile Flare(IC 6-1.1-7)
_ Nunn nt mmns,m.,r..,w.e.4..e.r _ __.it ,
CMATInDO po/ P lk annul_and,
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14 - 44434-
inty? • What Taxing Di strict? Has this deduction been requested an property
for current year?
❑ Yes ❑ No
COUNTYAUDfTOR .
Deduction approved in the annum of:
20 20 20 20 20 20 20
Signature of •/ Auditor // . County I Date(month,day,year)
4 A ' i ' 4 ,1/I/ ._ill )'Afi
I/ -e certify under the pen-ty -rjury that the above and foregoing information is true and oared and that the applicant is a resident of Indiana and
owner I contract buyer of the afo/re7m boned property on date application is filed.
fW '/)//L^/ /// Date(moth,day,year)
`W^resid1e�nt 115-Or(number and street,aly,sta e,( �ZI7P cede) j //^/ /- •
Person authorized by 11: o DQ M1 kit- d CI .J/.�/V ''/ /6&o Date(month,day Year)
Address of authorized person (number and street city,state,and ZIP code)/ •