HomeMy WebLinkAboutMortgage_Rowe (2) t••a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS p .1- y l • skim Year
� : FOR DEDUCTION FROM ASSESSED VALUATION . f
State Form 43709(R11/6-09) 'i i 1. _ �
Presuibed by Department of Loral Government Finance
INSTRUCTIONS: NOV 2 1 ag 4 NN
ark
Form 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.
Ring Dates: t) Real Property Must file during the year for which the deduction is sought • i n •unty Auditor
2)Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12) •l .':t - V I'Irtt
before March 31 of each year the deduction is sought GI BSO N COU TY M thitiliRecarder
See reverse side for additional instructions and qualifications.
Applicant( orwntract buyer .. . on reverse side) .
e. P �,
Tang 1 Key nanber/legal desaiptbn� Record number Page number
QYd� ln�M. is r — — 6_ -hnr_Rb(0 - O a o I y (3 9S
•
Assessed value teal property as of MAFA1wrnanggd/gq1yye/Contract indebtedness unpaid as of Mortgage I Convect• tedness unpaid as of Is the applicant the sole
March t:an nyear I,amen year data of applicator legal lIable owner?
1 d (�nbes ❑ No
If no,what Is his/her exact share of interest? ) If owned with someone other than spouse,indicate with wham
If name on record is different than that of applicant,indicate below: �{Iss t�hee property in question:Annually Assessed
Id1T<eal Property ❑AA yyAs Assessed
-Name of mortgagee or contract seller /
Address o mortgagee or contract seller(number and street,oily,stale.and ZIP code) /
Name of assignee or other owner or holder of mortgage t�('(�
Address of assignee(number and street,city state,and ZIP code) /0./! �(,O,I(S��` KA
Does applicant own property in any other If yes,what county? . What Taxing Dist 1 `� G c) ..— ,15�� N
county in Indiana? !�
❑ yes No
PPS i5q5
COUNTY AUDITOR 1
Deduction approved in the amount oh -
t
20 20 20 20 20 20 20_
Signature of County Auditor County Date(month,day,year)
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. .
notes(oArqs fug name) (pJ Date(month,day,year)
frelefrim 5:.N resident address of applicant(number and street,cdy,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0. Date(month,day,year)
Address of authonzed person (number and street,city,state and ZIP code) .