HomeMy WebLinkAboutMortgage_Griffin (2)Fir
s STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
" t FOR DEDUCTION FROM ASSESSED VALUATION 1
State Form 43709(R11/6-09) r
Presmbed by Department of local Government Finance
File Mark
INSTRUCTIONS: '
To be tiled in person or by mail with the County Auditor or County Recorder of the county where the property is located. F..
Ring Dates: 1) Real Property:Must file during the year for which the deduction is sought ty Auditor 2) Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months r before March 31 of each year the deduction is sought - - 1 .4...••_-
Sea reverse sidefor additionalinstructbns and qualifications. - GIBS H Al In)TOR
AppGmra(ownergcon . b.+- -see reverse side)
Taxing District a , Key neither/legal description Record number Page number
et- J $ . .., - r_ . - - - I- s_ -•At. 7 ( - ac • a Se
Assessed value cereal property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Conrad'indebtedness unpaid as of Is the applicant the sole
March 1;anent year March 1,current year date of appfl:Mien legal o Gable owner?
`-) QJS.V7) - ('Yes El
If no,what's 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 applicant,indicate below. GIsy.�pjepr�operty in question:Annually Assessed
LYi<�
Property ❑Annually Assessed
Mot>ae I+--'e(IC 6-1.1-7)
Na of mortgagee or contract sehef� /
(SJL WI_i^ '0 LY_I LO—V.z v— cm-Th
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage - — /' A IZ ry
Address of assignee(number and street,city,stale,and ZIP code) G^'�` I(- �vb
Does applicant own property in any other If yes,what county? • What Ta
county in Indiana?
❑ Yes o L3ao
COUNTY AUDITOR
Deduction approved In the amount of: -
20 20 20 20 20 20 20
•
Signature of CnmtyAuditor County Date(moNh,day,read
I I We certify under the penalty of perjury that the above and foregoing information is true and coned and that the applicant is a resident of Indiana and
owner I contract buyer of the aforementioned property on date application is filed. .
la wears/u0 rams Date(month,day,Yin iii Tn III�a���o�� A _/ y_ /�f• T/f ' Ityl /
73�l 1 .xr ofa mnt(Phi, Oi atelv-.1ar la) CAI I JV I7M,O .
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I Date(north,day,year)
Address of authorized person (number and street,dry.state,and ZIP code) .