HomeMy WebLinkAboutMortgage_Persinger (2) _ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
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FOR DEDUCTION FROM ASSESSED VALUATION
�c State Form 43709(Rtt/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: .
F. t-•191" .,. " I r
To be filed in person or by mail with the CountyAuditor or County Recorder of the county where the properly is located.
Fitirg Dates: 1) Real Property Must file during the year for which the deduction is sought County Aa(fter
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months
before March 31 of each year the deduction is sought er
See reverse side for additional instructions and qualifications. GIB:,:,.+ C." • - • • • •
(owner cc contract buyer-see re)str(ic''ross on reverse side)
�jKey n / description M� ' P e number
T Distrct ICey
- ro >&Cot :� aL - (a -On - tn4rbna R5 La- Dad' ao ► 9
Assessed value of real property as of Mortgage I Contract Indebtedness unpaid as of Mortgage/Contract Indebtedness unpaid as of Is the applicant the sole
March 1:wrest year Mann 1,current year data of app&caticn legal or sable owner?
lD1 btu - es ❑ No
If no,what's his/her exact share of interest? ) If owned with someone other than spouse,Indicate with whim ``
If name on record's dRen:nt than that of applicant Indicate belovr. the property in question:Annually Assessed
eal Property ❑ArmuaflyAssessed
Mobile Home(IC 6-1.1-7)
kbr 3N-21_ N et contract�seseller er
r l l X
Address of mortgagee or contract seller(number and street,city 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) .01,-,)), /R/� —
ef f\to ✓/��/J�
Dees applicant own property in any other If yes,what county? • What Tr ••••..
many in I liana? \\
❑ Yes No Ca rd No • / / 110
COUNTY AUDITOR �L1 •
Deduction approved in the amount of •
20 20 20 20 20 20 20
Signature of County Audtor County Date(month,day,)ear)
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
I w contract buyer the afot>;tnentioned property on date application is filed.
CC(rfSlq�P�/(olw�ana'ea"r/'s���t"- PIP) p �t �1("� •/�) Date(marsh.day,year)
POD-/" W. Sgteum -and ci f\state.a z,n code
V ' G ( 6 !0
Person authorized by duty executed Power of Attorney 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) .