HomeMy WebLinkAboutMortgage_Delong STATEMENT OF MORTGAGE OR CONTRACT IND IN SS ', /. ; Township Year.. ..
FOR DEDUCTION FROM ASSESSED VALUATION �j
', State Form 43709(Rtt/6-09) �/
•�@:zf' Presmbed by Department of Ind Government Finance
DEC 16 014 File Mark
INSTRUCTIONS:
Fomt fled With:
lb be filed in person or by mail with the CountyAuditor or County Recorder of the county where n-, prope.' � ted.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. ti:r -'1n1 Tp unty Auditor
2)Mobile/Manufactured Homes not assessed as Real Property.Must fit ��,�,�v��1 MAN
TO
March 31 of each year the deduction is sought �Re w Y:v "r County Recorder
See reverse side for additional instructions and qualifications.
Applicant(nene r contact buy -see restrctir on reverse side) •
b oY IdD o
Taxing 0' / Key number/legal prior Record number Page number
. 2 0'r t.') 2 4,- g 6,.?2 /-(/ `5-b-ev�
Assessed value of real property as of Mortgag9e/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1:current year Mardi 1,arrtrnt year date of appficatun legal ar equitable owned
7 Dd) ❑ Yes ❑ No
If no,what is 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,trdimte below- Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or nlu_ e / n
Address of mortgagee or contract seller(number and�stree�r. 4 city,state,and ZIP code)— [--e t--- Russ /�
Name of assignee or other owner or holder of mortgage b ujp6, Russ a
Address of assignee(number and street,city,state,and ZIP code) I q-15s—I a
Does applicant own property in any other If yes,what county? • ted on property
county in Indiana?
❑ Yes ❑ uo ills ❑ No
COUNTY AUDITOR
Deduction approved in the amount of -
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/contract buyer of the aforementioned property an date application is filed.
"attire ens full ) 6\ Date(north,day,year)
Full 'resident address of applicant(number and street sly, te,and ZIP code)
K t3 i v /2 5I0 844/, 1'd4-✓J /-tfrarch Sti ( f76`f
Person authored by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized d person (number and sheet city,state,end ZIP code) ,