HomeMy WebLinkAboutMortgage_Bradshaw (3) .a. . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
F
.C:.-5 : FOR DEDUCTION FROM ASSESSED VALUATION
-rr . State Form 43709(R11/6-09)
Presm'bed by Department of Loral Government Finance
File Mark
INSTRUCTIONS: Cr d�
lb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. r F4 3 tO 1 1A Y
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought ❑ County Auditor
2) Mobile/bie March f Manufactured Homes not assessed as Real Property.Must file during the twelve(12)months 'I , P_ .`, -ember
year the deduction is •Ir!17)I:
See reverse side for addiiti'ona linstructions and qualifications. GIBSONI,UU TV AUDITOR
Appficantyger^orco� nbDac�t buyer-mstr Cidiop on reverse side)
T District V Key numberI legal description Record number Page number
sr�✓ � A!� - DtI a '� - 3oa _ 000 . P1 (.o l0 0�0 20l `{ 55/ 3 '
Assessed value areal property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the app6nnt the sole
Marti 1;arrest year March 1,current year date of app6co io legal or equitable owner?
yr000 ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than spouse,ideate with whom
If name on record is afferent than that of applicant,Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Name of mortgagee or contact seller `l_ p
y
Address of mortgagee or contract seller(number r and sheet cty,state,and ZIP code) �Q �
Name of assignee or other owner or holder of mortgage Drawer NO v/lYl/�/j%//l(///"�
Address of assignee number and street,Qt/y,stale,aril ZIP code) Card 1`170.3`
•Does applicant own property in any other S(IIfffyyes,what county? • What Taxing District?
county in Indiana?
❑ Yes ❑ No I LJ Yes ❑ No
COUNTY AUDITOR
Deduction approved In the amount of:
20 20 20 20 20 20 20
Signs of Canty Auditor County Date(month,day,year)
I 1 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
1.....
owner I contract buyer of the aforementioned property on date application is filed. .
SI na (owners name) c ,, _ Date(month,day,year)
(moo V./-3
'� Full . ent of`app'frant(number and t�c�ry,smte,and ZIP code)
50 6 N MA T\ `f O i --OX 335 , V0A0VcL lq , Lk - (A, (o
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authored person (number and sheet,city,state.and ZIP code)