HomeMy WebLinkAboutMortgage_Neufelder :a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Fong 43709(R11/609)
Prescribed by Department of Local Government Finance F I I I,/
t
INSTRUCTIONS: .
7b be filed in person or by mail with the County Auditor or County Recorder of the county where the property F hl
ty fY P PertY slocated DE
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 31 of each year the deduction is sought - A :-• "' -ecorder
:
See reverse side for additional instructions and qualifications.
Applicant(owner or contract buyer-see restrictions on reverse side) C1DCON COUNTY AUDITOR
X o—'a- Li I'ii • ocu�
Taxing District/ Key number/legal viption Record number Page number
2/v —I -2— /2 -,2o/-000 . ASY- o2. .)- it] 111
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Marc i 1;current year March lament year date of application legal or equitable owner?
S 6I DOD ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone other than space,indicate with whom
If name on record is different than that of applicant,indicate below. I Is the property in question:Annually Assessed
Name of mortgagee or contract seller S 13 )s'e a ( o `o 1' � _
Address of mortgagee or contract seller(number and street,city,state,and ZIP code) I
Name of assignee or other owner or holder of mortgage I - I I I
Address of assignee(nut .- -n• ,state,and Z/p code eLeot J1 S
Dees applicant own property in any other /IIfffyyes,what county? • What Taxing Distna! I Has this deduction been requested on property
Indiana?in Inna? ❑ No for current year?
❑ Yes ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of
20 20 20 20 20 20 20
Sig of Camty Astor 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/contract buyer of the aforementioned property on date application is filed.
,Sig (ownefs )) Date(month,day,year)
‘$.4....X.` ant applicant(number and street,al%,state,and ZIP code)
2®4 61 Alai 54/ 0y../F/)51 /,0 977/5
Person authorized by duly executed of or by IC 6-1.1-12-0.7 / Date(month,day,year)
Address of authorized person (number and sheet,city,state,and ZIP code) .