HomeMy WebLinkAboutMortgage_Ankenbrand (2) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court .;..j.s' .•,ear
} It ; 1 IS
�;. FOR DEDUCTION FROM ASSESSED VALUATION 1
• ''?.t' State Form 43709(R11/6-09) ,
Presmbed by Department of local Govemmerrt Fuance
JAN1e46Q015
INSTRUCTIONS: .
lb be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located.
Form filed with: .
Fiimg Dates: 1) Real Property Must file during the year for which the deduction is sought ,`�7'' Auditor
2)Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12)mouths. Col N1I t��B¢ r
before March 31 of each year the deduction is sought wtsSON
See reverse side for additional instructions and qualifications.
Adwrcr�/b�er-seamravarse Q ��/� C / /
T ' , / J '�!/ � —'/ / //Z�(f��C-r���/ Record Pee numhu
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Assessed value of real property as of rtpage/Contract indebtedness unpaid as of Mortgage I Contact indebtedness impalas of Is the applicant the sole
Mardi 1,anent year Mardi 1,current year date of attaCa' legal or equitable owne?
ode) ❑ Yes ❑ No
If no,what is his/her exact share of interest? If owned with someone o than qv.icn,indicate with whom
If name on record is ddferent than that of applicant indicate below b perry in question:MnuaM Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller /��• t aged -
•Address of mortgagee or contract seller(number 4�te,and ZIP code)
Name of assignee or other owner or holder of mortgage /
I
Address of assignee(number and street city,sate,and ZIP code ��lr(�+W,�
Does applicant own property in any other If yes.wt /nh lI,,,,,s IJJ �.. 15- a.33 tuition been requested on properly
county in Indiana? ❑ No I V lki Vim ❑ Yes
❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount at •
20 20 20 20 _ 20 20 20_
Signature of County Auditor I County Date(main,day,riot)
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/co tract buyer of the afo mentioned property on date application is filed.
ASignature(o en's,r name Date(month,day,year)
•�j _(/! /) 1/ /G,(z oiy
Full re , V a.. •-..9(number /s Cate.afloat)�rfj) �]'��/':� J .
Person authorized by duty executed Power of Attorney or by IC 6-1.1.112-2-0L/7[ /�,J( Date(month,day,year)
Address of authorized person (number and street thy,state,and ZIP code) .