HomeMy WebLinkAboutMortgage_Midlin :a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Pty Township Year
t
FOR DEDUCTION FROM ASSESSED VALUATION
JState Form 43709(R11/6-09)
C•�R ':s' Prescibed by Departmerd of tool Government Finance
File
INSTRUCTIONS: i
DEC
b be filed in person or by mail with the Court Auditor or County Recorder of the county where the property t f�y�yh
Pe Y ty ty ty P PertY k located. 204 :
Fling Dates: 1) Real Property:Must file during the year for which the deduction is sought 9 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)mo
before March 31 of each year the deduction is sought - QI B ' -Cou+uy Recorder
See reverse side for additional instructions and qualifications. SON COU AUt?IT
Apparent(• • contact buyer-see strracos on rave ) _ �R
T-•: •R,•/ Key`�/legal desrnpt an .� -- • • •_ Page number
I, - it ■f6` . -O - L' - 7� . oioQ- el, F .Q/ 4�
Assessed value of real property as of Mort gage/Contract'7.tedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant the sole
March 1:=rent year March 1,current year date of application�� legal or equitable owner?
❑ 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 afferent Nan that of app8mnt,Indicate below: Is the perty in question:Annua%Assessed
' ,� / n ,, /n eel Property ❑Mobile Annually aAssesssed 1-7)
Noma of mortgagee. •' -�- iz =cJ ,\�/ C i{(//Ir'
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 end street,city,state,and ZIP code) _,/1�y'� r�t�I rz
Does applicant awn property in any other If yes,what county? • Wt JI"1/r nE� l /'�-J�/ !may
county in Indiana? ❑ yes ❑ No Ma a
[ ❑ No
COUNTY AU 't /_GI / 5
Deduction approved In the amount of • �l �.J
20. 20 20 20 20 1 20 I 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. .
Signature(owner's full name) Date(month,day,year)
7C A let - Noc ,�.�, P,4t ,�' �j4G Id- -/Y
Full resident address keplicant(number and steet city,state, e)
7O 8; V75. Ower`SVINc .=NZna y766 r
Person au read by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authatted person (number and stee;dry,state,and ZIP code) .