HomeMy WebLinkAboutMortgage_Sollman (12) 1,
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun !;110112 .iI h
f-�z„' FOR DEDUCTION FROM ASSESSED VALUATION 'I j
1.4S' Slate Form 43709(R11/6-09) . it
Rescobed by Department of Loral Government Finance
R€ ± 2014
INSTRUCTIONS:
To be filed hi person or by mail with the County uditor or County Recorder of the coup where the property FarAfled with:
b is county P Pe b s located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought Imr
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)monthC18$0 N fl•y1 Q R
before March 31 of each year the deduction is sought LY
See reverse -, for additional instructions and qualifications. ,,/��� �y�� ,
Applicant(o contract b re 78a¢sc-verse`'� ide<j� A L //'�al
�Y/(r�! / d Go'fi//'//�/,A"r' Record number, P
f/ I!r � 1r-3-Jon' oaa. Gel s- a0/� ibe .3
c. ..value d real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I indebtedness unpaid as of Is the applicant the sole
ili •`1,and year March 1,cement year date of application M.� legal or equitable owner?
/ Of�Jn atri ❑ Yes ❑ No
If no,what's Ns I her exact share of interest? If awned with someone otter n spouse,Indicate with whom
If name on record is different than that of applicant.indicate below rIs the property in question:Annually Assessed
ticReal Property El Annually Assessed
I\ Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller aide
`' Ill
Address of mortgagee or contract seller(number and sheet,city,staff,and ZIP code)
Name of assignee or other owner or holder of mortgage ^ 'n _ 4
Address of assignee(number and street,rill:state,and ZIP code) .( /J ) -
. Ng
Does applicant own property in any other If yes,what • What Toting District? Has this deduction been requested on property
county in Indiana? for curtent yea
❑ No r?
❑ Yes ❑ Yes ❑ No
Deduction approved in the amount at
20 20 Drawer NO..a./.cj 20 20
Signature of County Auditor Card NO. 9( E-:- - Date(month,day,,ear) -I I We certify under the penalty of perjur d that the applicant is a resident of Indiana and
owner I contract buyer of the afuaement .
SIgc&o(mimes rue name) / Date(month,day,year)
Full resident address of applicant(number and street,oily,state,and ZIP code)
/D O /.S r� qtr, •
Person authorized by duly executed Power of homey or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and sheet,city.state,and ZIP code) •