HomeMy WebLinkAboutMortgage_Brewster a_: STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun lilt.ship i lCait
FOR DEDUCTION FROM ASSESSED VALUATION i� 1:. t i.3
f-,': State Form 43709(R11/6-09) r
Prescribed by Department of Loral Government Finance
DEM"M0 2014
INSTRUCTIONS:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located. Form toed corer.
Filing Dates: 1) Real Property Must Me during the year for which the deduction is sought. ,L} ' _.4 .;;l•
2)Mobile/Manufactured Homes not aceeesed as Real Property.Must Me during the twelve(12)months y t ��•H$Reoerda�
before March 31 of each year the deduction is sought GIBBON�� r•• r.util l VR
See reverse side for additional instructions and qualifications.
Appfinerwmntranrt buyer-see resbicbwrs reverse side) `-�'`�l ^ Q / 1 1 L-�rUl"l� a ./�W2JOU—fLYL.(uF � C^�-GJ l.;-e�.a. (t�D,LA.. ~\\��'--�h.Q>_ (Ql\Ur b .). CA Page 379'`?
Assessed value of real property as of I Mortgage/Contract indebtedness unpaid daas of Mortgage/Contract indebtedness unpaid as of Is the app&ant the sole
March 1:alma year Mann 1,current win. data of application legal or de owner?
Dfyoa es ❑ No
d na,what Is his/her exact share of interest? 'T If mimed with someone other than sparse,indicate with whom
If name on record is different than that of applicant,Indicate below Is the property in question:Annually Assessed
keal Property AnnuallyAssessed
Mobile Home QC 6-1A-7)
Narr�p{(mortgagee or contract seller —
—
i.SYyO ,i �7 �aitn > - — M
Address of mortgagee or contract seller(n and street,city,stare,and ZIP code) I /�JD/YI,�/!, 1
Name of assignee or other owner or holder of mortgage /'�f r /LJ)�
Address of assignee(number and street city,state,and ZIP code) 3 944
Does applicant own property in any other If yes,what county? • What i �' •I_I '
county in Indiana? ,-y7
try Yes ❑ No _ r No
L COUNTY AUD TOI
Deduction approved in the amount of:
20 20 20 20 20 20 20 -
Signature of County Auditor County Date(north,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 'oned property on date application is filed.
•nature owners M ) Date(month,day,year)
—` / • s s _■ 4
resden •=. . appGmxt(num.-r and state,and ZIP code)
kel grin F - ,l=treet ad 1,24 •
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .