HomeMy WebLinkAboutMortgage_Seifers . ._. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
ak -C;` FOR DEDUCTION FROM ASSESSED VALUATION
State Font 43709(R11/6-09)
Prescribed by Department of Local Government Finance
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INSTRUCTIONS: filed with:
To be tiled in person or by mall with the CountyAuditor or County Recorder of the county vrh p
Flog Oates: 1) Real Properly: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 twglva f121 nth
County Recorder
before March 31 of each year the deduction is sought - J/-11V U
See reverse side for additional instructions and qualifications.
Apprcara(o - or.. tract boyar. - - .,. ..:side) f I. o
'IS 411 r u r' �I?7111r
}'rg P. 4 Key jg /legal d l..'.tmn V-"/• `O Record ber Page number
1
f r ' \ C(iP'OS - 3S- o° (oS/ • // 3
Assessed value of real pa um as of Mortgage/Contract indebtedness unpaid as of \ c
March 1;anew year March 1,moment Mortgage indebtedness unpaid as of legal orpequitable owner?
`3 g ID ❑ 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 applicant,Indicate belovr. Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract serer(number and street city:sate,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street city,state,and ZIP code) C=7015 3 i
•
Des a^pacanttoown property in any other If yes,what county? • 4 (7 tperty
❑ yes 0 N 4 53lg IOC - ❑ No
COUNTY A Oa) r1OT0 /L
Deduction approved in the amount of f 4�7�c/(��
20 20 20 20 Cyy.M►(til
Signature of County Auditor C
I I We certify under the penalty of perjury that the above and foregoing informa na and
owner I contract buyer of the aforementioned property on date application is fit
•nature • • MI name)
W resid: t address of applicant(number and •-/1 ctry,stair,- and ZIP code)
�l{1J�/�t(P ■ -1a3 L c acv Al E.'2iNee /r7N/ /N 476, 7v
Person authored by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street day,state,and ZIP code)