HomeMy WebLinkAboutMortgage_Andrecht F _.
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Countyl�IT�}msl itar
��;r;; FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Presoibed by Department of Local Government Finance
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INSTRUCTIONS: t ! •
Form filed with. _
Tb be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought. , ❑ S.unty• alto
2) Mobile/Manufactured Homes not assessed as Real Property Must Me during the twelve(12)months '�i V'1'715: Recorder
before March 31 of each year the deduction is sought 01880 ! ti _
See reverse '•a for additional instructions and qualifications.
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APPf�nt ier or uyer- e on re � e O 4 lLI t / Al
Page Two ke9_, / 1/� /-.O.0/ / o?-oO/ 777 �-�"
Q/
Assessed value of real mp�yt as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appfaant the sole
March 1:ament year P id March 1,=rent year data of aPpfce z //a/CO legal ❑ Yes ❑ No
If no,what is his I her exact share of interest? If owned with someone other than spouse,Indicate with whom
If name on record is different than that of ap "uate.below. Is property in question:Annually Assessed
Real Property El Assessed
• Mobile Home(IC 6-11-7)
Name of mortgagee or contract seller ^ n ! /j
Address of mortgagee or contract seller in and street,city,state,and code)
U
Name of assignee or other ovew or holder of mortgage ///111
Address of assignee(number and sheet.�,state,and ZIP code) //�
/(/ /al —a —// 606 en e.
Does applicant own property in any other I If yes,what county? • What Taxing District? Has this deduction been requested an property
county in Indiana? ❑ Yes for current year?
n 1 � +1❑ Nei__ ❑ Yes ❑ No _
Rt DRtCk Ii STEP�itP C 'AUDITOR
Deduction appro V-c N,/f/ Q
ICY �' iJ
20 � ( c,3q/ _ 20 20 20
Signature of Cour County Date(month,day,year)
I I We certify n -, .....,...ration is true and correct and that the applicant is a resident of Indiana and
owner I canto____,... ,.,u ie arurementioned property on date application is filed.
Signs (owners full name Date(month,day,year)
alt. ... . (1 Ah .
\t,
Futitesdent address of applicant(number and sheet.sly:step,and ZIP code)
53,9 Ili. `Pf C0� (.lam `Fiiy n41_/ny '.ai.;alt., 4/7&IO
Person authorized by duduly er ted Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street d(y,state.and ZIP code) .