HomeMy WebLinkAboutMortgage_Brownell STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Counryryry Townshi Year
FOR DEDUCTION FROM ASSESSED VALUATION 141 L E N �i
Arerritn State Form 43709(RU/6-09)
Presaibed by Department of Local Government Firwoe
File Mark
INSTRUCTIONS: DEC . -EC r,.
To be riled in person or by mail with the County Auditor or County Recorder of the county where the property is located.
firing Dates: f) Real Property:Must file during the year for which the deduction is •un • ditor
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)month 4 f..._./
before March 31 of each year the deduction is sought - 4, Vet,gir aunty Recorder
See reverse side for additional instructions and qualifications. G I BSO N Cs . - . . . -
Applicant(owner or contract buyer;see recrictions on reverse sii1A) iek...erto.......n.teL
T • District Key number l legal description Record number Page number
a!, - 23 -!(o-aoo - co A.. 5 v8 - a a- C1 ,t o/ c( 5/.s'9
vahre of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/ConYxt indebtedness unpaid as of Is the appOcant the sole
March 1;anent year Maw 1,current year date of application legal a equitable owner?
A
If no,what is his/her exact share of interest? If owned with er� oo
spouse, ❑ Yes ❑ No
Indicate with whom
If name on record is different than that of applicant,Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobde Home(IC 6-1.1-7)
Name of mortgagee or contract seller //
Address of mortgagee a contract seller(number and street,city,st . ,and ZIP code) L{/�
Name of assignee or other owner or holder of mortgage
Address of assignee(number end street,city,state,and ZIP code)
Does applicant own property in any other If yes,what county? • What Taring District? D ra I N•county in Indiana? ❑ Yes .
❑ No coin/
Cat- 1 .......
COUNTY AUDITOR a )�O. ,I� ^� 9
Deduction approved m the amount of - fj d q ) c•I...:.:..:
20 20 20 20 20 20 -
I 0M.l
Signs of`4 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
owner I contract buyer of the aforementioned property on date application is filed. .
wre(owner's rut .. ee Date(nigh,day,year)
X tt . , 41 J hf A / /
em pddress of applicant(number and street,01);state,and ZIP ode)
I if 20 U VI Co(n -Pet SS —a,c( Ghsdzcd.- /IV LI 9 •
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Dale(math,da%year)
Address of authorized person (number and street,city,state,and ZIP code)