HomeMy WebLinkAboutMortgage_Kermode ,¢ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
;tit; FOR DEDUCTION FROM ASSESSED V rtj �--f `,
tt. State Form 43709(R11/6-09) ELH
Prescribed by Department of Lod Government Finance
File Mark
INSTRUCTIONS: DEC 1 14
To be filed in person or by mail with the County Auditor or County Recorder of the county where me property is located Form Red wilt
Filing Dates: 1) Real Property Must file during the year for which the deductio is sought. Kle County Auditor
2)Mobile/Manufactured Homes not assessed as Real Prope ust file (72)months
before March 31 of each year the deduction is ht •fPrL� ❑ County Recorder
See reverse side for additional instructions and qualifications.
COUNTY AUDITOR
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—VQ^•�r '�—V c�D Reap}corm/ Porky/1377z
/tot_ 6(b-0 -aS— �IrO J `Y �c�
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the apogean the sole
March 1,cu cot year March 1,nrrtert wars date of application legal a equitable owner?
I �5 S8j ❑ Yes 0 No
If no,what is his/her exact share of interest? If owned with someone other than renew.,indicate with whom
If name on record is Nilerent than that of apogean;Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
• ^ W I� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller (,(�G\) \\ (
Address of mortgagee or contract seller(number and street,city,state,and7JP code)
Name of assignee or other owner or holder of mortgage
D I';)){'e I- )Ar o. � // ay? . what Taxing District? Rama deduction been requested en property
........1`�•••••• for current year?
El Yes
/ // ❑ No
Card 1\70. ( COUNTY AUDITOR
20 20 I 20 20
JI _ 20 20 20
Sigre Co rx Ardioi Coon. I 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 I contract buyer f the�}emeentioonneeddpropertyon dat jpptication is filed.
���futI a) / Date(month,day,year)
F)I�resi/d8 ent address of apogean (number and street,ply,state,.. ZIP code) P //
Person authorized by duly executed Power of Attorney or by IC 61.1-12 Date(month,day,year)
Address of authorized person (number and sheet,city,state,and ZIP code)
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