HomeMy WebLinkAboutMortgage_Loveless ak�,:�k . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
0 FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/509)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: .
b in be Ned person or by mad with the County Auditor or County Recorder of the county where the property is located.
For, i:1 115
Ring 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 - .,•1,u,e_y? .11
See reverse side for additional instructions and qualifications. ' • ' • • TY AUDITOR
el- Ors e dd
T D'/i / Lr 17-Q - s'o -0 / Vo / t) 6 IRecoN member` Pal number
3
Assessed value of real pr }psss of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1:rarert year Marc 1,current year date of app
l legal or equitable❑ Yes ow owner?
If no,what Is his/her exact share of interest? If owned with someone other t�spouse,indicate with wiorn
If name on record is different than that of applicant,indicate below Is property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller ,y1
- ? /rr a, A.
Address of mortgagee or contract seller(nr?and street,coy,state.. .ZIP code) {-1 II,, 7`, ll�� TT/�
Name of assignee or other owner afxdder of Mortgage 547
1-0U.t ��Sr x14 oo( a JK
Address of assignee(number and street,city,state,and ZIP �� �� �'� J U D
I `i -5153
Does applicant own property in any other If yes,what county? • What Taxing District?
county in I diana? I for amen year:
1:11 Yes ❑ No ❑ Yes U No I
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 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
ownerntract buyer of the aforementioned property on date application is filed.
SIg f Qo`'' G�na/me)/ Date(month,day,year)czci
11).) MA resident address of applicant(num.•r and street,Gay,sta ,and ZIP code)
; • S ' . 0
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(noon,day,year)
Address of authorized person (number and street,city,state,and ZIP code)