HomeMy WebLinkAboutMortgage_Grabbe e. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS county h liecip
FOR DEDUCTION FROM ASSESSED VALUATION
Lor
-"' State Form 43709(R11/6-09)
Prescribed by Department of Lod Government Finance
FBe ilieV 19 2014
INSTRUCTIONS: .
Fain filed with:
To be filed 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 • -1
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months t%r) �1>t/fVI,
before March 31 of each year the deductions sought - GIB MN "4 '• 'UDITOR
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer
buye r- restrictions on reverse side)/
44tt >
•
-1144-74Z/1 tar-I
T O L� o, I r-/ number/legal description c nc.2Qv
Record number
Plo- 1�?- 900 .00,2 l O _ a0/ g40 7 Assessed value of real property as of IAbnpage/��tra indebtedness unpaid as of Mortgage� indebtedness unpaid as of Is the or applicant
quitable the sole
Mardi 1:anent year Marti 1
411000 ❑ Yes ❑ No
If no,what's 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
El Real Property ❑Annual/Assessed
- Mobile Home QC 6-1.1-7)
Name of mortgagee or contract seller
l � 1 �c �. u •
Address of mortgagee or contract seller(number and street. ,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assn t and e) •
•
Does applicant own property in any other If yes,what county? • Tiles this deduction been requested on property
county in Indiana? -__-
❑ Yes ❑ No t'-s ❑ No
•COUN" ' nra{YCr 1�r+ 44)/9'Deduction approved in the amount at. - O... . ... ..
20 20 20 20. Cara No .....'(QO? 20
,rei "7'h-s�C"J�.� County I uaw,.._.._. tr)
I 1 We certify under the penalty of perjury that the above and foregoing information is tote and correct and that the applicant is a resident of Indiana and
owner/contract buyer of the aforementioned property on date application is filed.
•irr.re(owner's rd e) Date(month,day,year)
C\CI\C c),
t Full era address of applicant(number and -- Wy,state,and P code)
• w A . . ,. • • a - • %C. -1 -■ tLi ea
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,may:state,and ZIP code)