Mortgage_Toth . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun j�?ICHI a]
11 FOR DEDUCTION FROM ASSESSED VALUATION ? , ;MP 1 !IIIIf
_. #:: State Form 43709(R11/6-09)
44' e Prescribed by Department of Local Government Finance
File mtIQV 2.4 2014
INSTRUCTIONS:
Fo D w h:
To be filed in person or by mail with the CountyAuditor 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
2)Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)months p�►11,t,�nl t
before March 3l of each year the deduction is sought - I �-• .arhnr idl l Dl OR
See reverse side�for additional instructions and qualificat ions.' /
Record num Page
valued � /20 -a�00- wog i2Dat/ ao27 306
real as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1,current year March 1,atnent/y�/a�_ T �I�-1 date of application legal or equitable owner?
/ `mod/ (WC) ❑ 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 record is different than that of applicant indicate below - Iyttye property in question:Annuaty Assessed
pU Real Properly El ru
Awally Assessed
/ ` Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller n / Q n� n
Address of mortgagee or contract seller(number(aandsstree�et,�ay,,�statte,and ZIP coda) t / /� /) 07'
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sheet,city,state,and ZIP rode)
•
Does applicant own property in any other If yes,what county? . What Taxing District? Has this deduction been requested on property
❑ Yes ❑ No for current year?
❑ Yes ❑ No
COI _
Deduction approved in the amount of: - 1-6114- p A_) f'i-L S
20 20 • 20 2 *)c 20
Signature of County Auditor 14" l 0 sac) - —
I/We certify under the penalty of perjury that the above and foregoiru tnt of Indiana and
owner/contract buyer of the aforementioned property on date applit
Signature(owner's butt name) !ear)
Full rpident address.01/vutdof applicant(number and street,ally,state,and ZIP code)
X 3`2- 62 w, y 7S S , Owe,I-13c.„Gle .4--A, '1?6066(--
Person authorized by duly executed Power of Attorney or by IC 6-t1-12-0.7 Date(month,day,year)
Address of authorized person (number and sbee4 ciN,state,and ZIP code) .