HomeMy WebLinkAboutMortgage_McEllhiney (6) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Counr!!rE;�it ' i-
~e: FOR DEDUCTION FROM ASSESSED VALUATION l( I IV
• State Form 43709(R71/6-09) .
Prescnbed by Department of Lod Government Anna O elpr
r20 iQ
INSTRUCTIONS: .
ohm Ned with:
To be tiled 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. Auditor
2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)moGmSON C IUN Milg&
before March 31 of each year the deduction is sought -
See reverse side for additional instructions and qualifications.
Appbcanl •. b -sseea/ reveres side D� l /P/ a
T.: s Key number/legal d,.r.°�5, Rage'number
4 .,l d -//-t- oW - t613 ,3,3- a3 o ,3
• -.value teal as of Mortgage/Contract Indebtedness unpaid as of Mortgage/ tract indebtedness unpaid as of Is the appfmant th�
March 1:anentyear March 1,anent year date of ap legal or eWitable wmrfl
/60 ❑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 read is dPerent than that of applicant,indicate below: Is property in question:Annually Assessed
Real Property ❑AmwatyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
X'iI!) 1.C-,
Address of mortgagee or contract seller(number and street,(21/210-1-.11//e-
ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,�1:store,and LP code) �// �/( Q O) / ��/�') 1 ��
Does applicant ova property in any other If yes,what county? • /, What Taxing{Jq'S/''�' ? Has this deduction been reghksted7
county n Indiana? n_.._. rn _ —_ V for current year? ❑ Yes ❑ No GE-vg6.co /I
p')cacIwley ,1
COUNTY AUDITOR
I�-343LD _[J {rn-(S I l 1.00 20 20 20 20
- Par/.. W, O- Inot fact County Date(mond;day.year)
I I We certify under the penalty of perjury that the above a and foregoing information is true and correct and that the applicant is a resident of Indiana and
c er I contract buyer of the aforementioned property on date application is filed.
1/ Si.t re(owner's fu0 ro Date(month,day,year)
ed,( Full resident of applicant(number and street, e• n ZIP code)
1 $13 10. En - �/) t ✓Ltmmies sP) 47670
Person authorized by duly executed Power of Attorney or by IC 6-1.1-1247 / Date(mores,day,year)
Address of authorized person (number and saes;illy,state,and VP code) .