HomeMy WebLinkAboutMortgage_Thompson STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a s FOR DEDUCTION FROM ASSESSED VALUATION
Slate Form 43709(R11/6-09)
Presmbed by Department of Local Government Finance IP I LE I )
INSTRUCTIONS:
To be filed in person or b mad with the County Auditor or County Recorder of the county where the property orm tiled With:
by ty ry ty p pre ty s located. DEC 1 i'thn:'A
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought D " �i G80rtly Auditor
2)Mobile/Manufactured Homes not aesansed as Real Property.Must tile during the twelve(12)months
before March 31 of each year the deduction is sought - ❑ County Recorder
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See reverse side for additional instructions and qualifications.
Aeon t(owner or contract buyer-see rejt" ns on reverse side) CIBSON COON I Y AUDITOR
Taxing District , number/legal desa number
ip0on Record number Page numb
diz.a aeo a6 -/3 . '.o -io3 _000 , / 5c(-00..5 14 CODLI
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1:current year March 1,current year date of appficatbn legal equitable owner?
i
If no what is his I her exact share of interest? If owned with someone other th�n spouse,indicate with whom
❑ Yes ❑ No
If name on record is ddferent than that of applicant.indicate below. _ — —
li,m P_50 hp AND Qa()
Name of mortgagee or contract seller
C 8 L 7'L . C -,.S%J -6a4„,"—' 0 l3C meia404-/- /3AP4
Address of mortgagee or contract seller(number and sheet,city,state,and LP code)
Name of assignee or other water or holder of mortgage /q_$b0 Ci
Address of assignee(numbedd street,ca):stale,and ZIP code)
SO own in t�� y 1 4
county applicant awn property in any other If yes,what county? • What Taxing District? for Has this current deduction been requested on property
❑ Yes ❑ No y� ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of.
20_ 20 20 20 20 20 20
Signs re of County Amstar `_ County Date(month,day,year)
i c!T/A"•cL' � A N
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
Amer/contract buyer of the aforementioned property on date application is filed. .
XSignature(o me) Date(month,day,year)
J Full resident address of cup t(number and&beef,tidy,state,and ZIP code)
3o II • /1Ade)[c Sr C P(7C1Ci CO Tx) Y7 -7P Person authorized by duty executed Power of Attorney or bf IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,cry,state,and ZIP code) .