HomeMy WebLinkAboutMortgage_Bradshaw (6) _E a . STATEMENT OF MORTGAGE OR CONTRA TE County Township Year
, �:` FOR DEDUCTION FROM ASSESSED VALU 0
- 1. State Form 43709(R11/6-09)
Prescribed by Department of Local Government Rreoce
S
1 la EC — 10` File Mark
INSTRUCTIONS: .
To be filed in person or by mail with the County Auditor or County Recorder of the county •- -re th>L rrl :L: s 1 Form acct with:
Filing Dates: 1) Real Property Must file during the year for which the deduction is so • 1, .���y {�VOt"' County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file i• •It •sge(12)months
before March 31 of each year the deductions sought -.tg$ON ❑ County Recorder
See reverse side for additional instructions and qualifications.
Appficaan't(owner occonrract -see . .ohs on reverse side) [J ' /
C /1Jr" f/f) �xxJ71 12� 4 l4.41_12771.17 7 Al /UQ/�ij,
Taxing Disbict /� Key number/legal description Rend number Page number
AnteC g h - 9-/'9 -A0 YS , 39S -o� G, r.7o i 350 /
value of real properly as of Mortgage/Contract indebtedness unpaid as of age I Contract indebtedness unpaid as of Is the applicant the sole
Math 1:ascent year Mardi 1.a ,-1 date of ago/motion legal or equitable owner?
yy0C / ❑ 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 app rant,indicate below. Is the property in question:Annuaty Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or con seller
Address of mortgagee or ccontract seller(number and sheet,city state,and ZIP code)
Drawer NO.......
Name of assignee or other owner or holder of mortgage ............"1 //�(n/ .�
Address of assignee(number and sheet,city,state,and ZIP code) Ca))-t? \1�(/ 0/yam . Y V .l I
Does applicant own property in any other If yes,what county? • pasted on property
county in Indiana?
❑ Yes ❑ No I , I Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20_ 20 20 20 20 20 20
Signature of Courtly Auditor County Date(month,day,year)
I 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 of the aforementioned property on date application is filed. .
Slgnah,r.400wners lame) �] �� Date(month,day,year)
YJL4i'sLM weran /7cccc'>
Full resent address appll ant(number and sheet,cty,state,and ZIP code)
IC /005 S Centc S et h rock 5ranck , H L11Gi4 8 executed Power of Attorney or Person 1 I 1 Dae(mnnN,day year)
Address of authorized person (number and street city,state,and LP code) .