HomeMy WebLinkAboutMortgage_Wolf _. STATEMENT OF MORTGAGE OR CONTRAC PI Township Year
FOR DEDUCTION FROM ASSESSED VALUA )•
State Form 43719(R11/6-09) O 1Q+
Prescribed by Department of Local Government Finance 1(�N 1
Jt'� File Mark
INSTRUCTIONS:
To be filed in person or by mail with the CountyAuditor or County Recorder of the county w .) - f.i€77,7 T. R Form coed with:
Rig Dates: I) Real Property Must file during the year for which the deduction is sough. 7w( NJ ? County Auditor
2)Mobile
March 31 each year the deduction is sought Must a- i Ive(12)months County Recorder
See reverse side for additional instructions and qualifications. 1
AppG(an (owner• contract 9— see( (PS ' m reverse site) t r1
Taxing• I / Key rwm{berr//(legal l description / Record number Page number
1' —4;74/7 C96— 6y-�5- / / Orr/ c7 o PO aoo 6, //47
-.value of real property as of Mortgage/Concoct indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the appl ant the sole
Marts 1:anent year Ma 1 wrrent year date of appficotion legal or equitable mwwYl
OMV Vl • ❑ Yes ❑ No
If no,what is his/her exact share of interest? te I If owned with someone other than spouse,indicate with wham
If name on record is different than that of apfACant.indicate below` perty in question:Annually Assessed
Real Property ❑Mobile Moble Home(IC 6-1.1-7)
Name of rnirrtgageTontract seller
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Address nwngagee se'Inumber and street . state,and ZIP code) (((���_///���
Name of assignee or other owner or holder of mortgage �/`/,/ n
Drawer NO UvI //
Address of assignee(number and street,city,state,and ZIP code) C'./f/
Dees applicant own property in any other If yes,what county? • Card NO. l l don property
county In Indiana?
❑ Yes ❑ No t 1 u res ❑ No
COUNTY AUDITOR
Deduction approved in the amount ot: •
•
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
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.
gnatre(owners MI name)) Date(month,day,year)
/"� g [ter/�(I/
W/� addre t nranber and street, state,and ZIP code) .
� yos �. Si7v c�l/ 17d 6/.
son authorized by duty execoted Power of Aitomey or by IC 6-1.1- 2-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .