HomeMy WebLinkAboutMortgage_Meyer (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Tvnshhi t 1 r
FOR DEDUCTION FROM ASSESSED VALUATION �d n e I i
•
' .'..+1.e--' State Form 43709(R11/6-09)
Prescnbed by Department of Local Government Finance /t /� Dc¢hark 201 r
INSTRUCTIONS: �/ \1 .
F• • Led
To be filed in person or by mail with the CountyAuditor or County Recorder of the county where the property is located. 1�
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. ''1 r�!:e!!i• ditor
2) Mobile/Manufactured Homes not assessed as Real Property Must hle during the twelve(12)moniGSBS•N ry '4 AI R
before March 31 of each year the deduction is sought.
See reverse side for additional instructions and qualifications.
Apppli`ccaa1lnt(owner or buyer-see rtsricf rte 'rse side) cJ /2 ,,
T.. r. . . ! enber/legal desaiption - .... •_ Page ' •.•
// — - — •_ • tn • # • 00 lii 00.40
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the appGrant the sole
March Lanett year March 1�/year f�O 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,indite with whom
If name on record is different than that of applicants Indicate below. Is the property in question:Annually Assessed
. eel Property ❑PmualyAssesscd
Mobile Home(IC 61.1-7)
Name of _ -,- •. .• •-d seller • /
- 11�a1i—a ��yyyttt �A /y1- _..
Address of �...ee w con.. �seler(number and street,cal,state,and // I Ei/ //�, J/�/1(Js f '/1
Name of assignee or other owner or holder of mortgage /_L {_n�" x/.3/ �N"
Address of assignee(number and street,city,state,and ZIP code) G c../�---+/ 4r -66179
Does applicant own property in any other If yes,what county n requested on property
county in Indiana?
❑ yes ❑ No I l . ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Signature of County Auditor ' County Date(month,day,year)
I 1 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
Amer/contract buyer of the aforementioned property on date application is filed. -
re o name) Date(month,day,year)
`�den_�ap t nom rand Tree!,any,state,and ZIP code)
3o i w. rn C 4 P a (-4-• Waubsindl - n) 47(0 q
Person authorized by duty executed Pow of Attorney or by IC 6-1.1-12-0.7 Date(month,day,)ear)
Address of authorized person (number and street,dry,state,and ZIP rode)