HomeMy WebLinkAboutMortgage_Griffin (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION J F/
Lslate Form 43709(R71/6-09)
Prescribed by Department of local Government Finance
File Mark
INSTRUCTIONS: 10I4
To be filed in person or by mail with the County Auditor or Court Recorder of the county where the property Fortq
Pe Y tY h b P Pamirs located.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months r^' 1�
before March 31 of each year the deduction is sought EIP)ll rRit co)
-See reverse side for additional instructions and dqqualifications. GIbSUN UUUNIT AUuli OR
App ,to1q A ) I'�° (D�
T ,N / /legal description Record number Page
7[ o f 2-V9'460'00/ N —o�z/ do/ -Cc
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Assessed value teal property as of Mortgage/Contract Indebtedness unpaid as of Mortgage 1 Contact indebtedness unpaid as of Is the applicant the sole
March 1:=midyear Mann 1,orient year data of appliicatm legal or equitable owner?
/// /
F 0 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than space,Indicate with whom
If name on record is different than that of applicant,indicate below. \Is property in question:AnnuallyAssevM
Real Property ❑Annually Assessed
/lam Mobile Home(IC 61.1-7)
Name of mortgagee or contract at We
Address of mortgagee or contract seller(number and street,city.state.and ZIP code)
Name of assignee or other owner or holder of mortgage
Az }2E /7- 3 —/al AHa,
Address of assignee(number and street,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? ❑ Yes ❑ No for current year? ❑ Yes
❑ No
COUNTY AUDROR
Deduction approved in the amount of • _
20 20 20 20
Signature of County 020 l�I miry Date(money day,year)
-.Drawer NO 1 ,
I I We certify tit ion is true and correct and that the applicant is a resident of Indiana and
owner/central �/ 5 d.
1 Sig re(owner's: Card NO. J((I - 1 Date(month,day,year)
yl``Full resident 4 II I) I5 O°CP/
/o i yjSg /6 $ ' oven 5‘1)ye :Li 1/766S
Person authorized by duly executed Power ofAttaney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) •