HomeMy WebLinkAboutMortgage_Sunderman t STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,A FOR DEDUCTION FROM ASSESSED VALUATION
State Farm 43709(R71/6-09)
v> )
Prescribed by Department of Local Government Finance t
1 Ire- a _
WSTRUC77ONS: .
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located rFartn fled cunt
Filing Dates: 1) Real Properly:Must file during the year for which the deduction is sought ND V 1 110 140unty Auditor
2) Mobile/Manufactured Homes not assessed as Real Property.Must Re during the tweNe(12)months ,
before March 31 of each year the deduction is sought ❑ County Recorder
See reverse side for additional instructions and qualifications. i,,, 4r►17
T '('�� 6 * — j' ` NTY AUDITOR
l�`- KKeyynmiber/legal desoiptbn Record Page
trio a ( —/a -D7 - aO3 - oo3 - 395 - ens' o?o y 4..
value d real pr petty as d I Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the appfimnt the sole
March 1:current year March 1,current year date of application legal or equitable owner?
ICI 5 3 O ❑ yes ❑ No
If no,what is his/her exact share of Interest? If owned with someone other than spouse,indicate with wMrn
If name on record is different than that of applicant,Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• Mobde Home(IC 6-1.1-7)
Name of mortgagee Of con seller
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) _ _,�
. �— •
Does applicant What Taxing District? Has this deduction been requested on property
county in Indian aW yy r tfin f(Ynn 1 for ainent year? ❑ Yes ❑ No
A"r ` _
^ 'AUDITOR
Deduction apprc n.. 'fl P` h I _
20 �i,iJ, +�u-, 1 'I g W _ 20 20 20
Signature of Cw 1--� r-1 County ' Date(month,day,year)
I IWecrM1fyund -C, YLA-�A�
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
owner)contract buyer of the aforementioned property on date application is filed.
V*nett ) Date(month,day,year)yz..4...0...e....erex_.- f7,'/ '
F ont of appGcont bet and t aly,state,ra�nt�L-P� code) - �t Date mo y(
Person authorized by duly executed Power of Attorney or by Cl 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state.and ZIP code) .