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HomeMy WebLinkAboutMortgage_Gewirtzman STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun 1_�©; - I.,,ear e'`�' r;;` FOR DEDUCTION FROM ASSESSED VALUATION ( !� !i iserktAi l .( ) ,::.54..s. State Form 43709(RD/6-09) - Prescnbed by Depwbnent of Local Government Finance `1l ,� fi,'M►rk/ INSTRUCTIONS: rOV,eJv `, Form bled with To be fled in person or by mad 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. �1,, , P1_t __) 2) Mobile/Manufactured Homes the deduction is sought Property Must file during the twelve(12)m SO C• I: Recorder before March 31 of each Win' I, Recorder• ; See reverse side for additional instructions and qualifications. or sr buyer- ee red.iction< reverse e) 7 ayie./o/2 7 Crn"9;07 Ta- istrct Key ru mberl tan Record nonYr Page 1�.>f� sL /alt o?t/o -%�-404- ,�. ld�U - tract el()/It- 6 Assessed value of real property as of Mortgage I Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid of Is the applicant the e Mardi 1:current year Mardi i,current year dale of apP� /,r 00�� El 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 different than that of applicant.indicate below. Is the property in question:Annually Assessed eel Property ❑An uallyAssessed Mobile Home(IC 6-1.1-7) • Name of mortgagee or contract seller /�� Address of mortgagee or contract seller(number and street,city,scare, ZIP code)/0//A5n1 Name o<assupree wottter ovneror hider of mortgage //J'Address of assignee(number and street dty,state,and ZIP code) / ttcd • Does appfrant own property in any other If yes,what county? • What Taring District? (/Has this deduction been requested on property county in Indiana? ❑ No ter amen year? ❑ Yes ❑ yes ❑ No COUNTY AUDITOR Deduction approved in the amount of - 20 20 20 20 20 1 20 20 _ __ - SigSignature of s Cormty Auditor County • 1. _ I/We certify under the penalty of perjury that the above and foregoing Information is 1n /1 a owner I contract buyer of the aforementioned property on date application is filed. f w-,Gl ////JJJ� I/L^/�.. ^I' _ � ) — ! ame `-�"°" ' �^ CD1 LC L -I resident.• appticant(number and street oh:state,and ZIP code) / — Person authorized by duty executed Power of Attorney or by IC 5-1.1-12-0.7 Address of authorized person (number and street city,state,and ZIP code)