HomeMy WebLinkAboutMortgage_Conway et. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County i Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
-a.:ti State Form 43709(R11/6-09) j) .
Prescribed by Department of Local Governed France 1
INSTRUCI7ONS: pod .
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located /I I�jur
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought rU County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must h7e during the twelve(12)months
before March 31 of each year the deduction is sought - 4 • -- Recorder
-See reverse side for additional instructions and qualifications. r^f""*� �r
GIRQON COUNTY AUDITOR
pip (owner or contract"seams. ' on reverse side) A
Tad Istria c Key number/ I description Record number Page number
CO.--2 eel -tie /A /03 -0 0 a . A79/ - o ?- 8 ao ( Y 9 , 3q
Assessed vale of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March 1:current year March 1,current year date of app5etm legal or equitable owner?
If oo,what's his/her exact share of interest? If owned with someone other'than kpouse,�e with whom ❑ Yes ❑ No
If name on record is afferent than that of applicant,Indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Anrluafy Assessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller n 6 — A: .J `
Address of mortgagee or contract seller(number and street.city,stare,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of 'gnee(number and street,city state,and ZIP code)
. it., id r?-0 /19
Does applicant own property in any other If yes,what county? • What Taxing District? Has this deduction been requested on property
county in Indiana? for current year?
❑ Yes ❑ No El Yes No
COUNTY AUDITOR ^^y1
Deduction approved in the amount of • Drawer NO ,Y`O ici
20 20 20 20 20_ Card NO. �(sy
Signature of County Auditor � �/�� �r County
�, � J I
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
owner I contract uyer of the aforementioned property on date application is filed.
Slgnaturejovmers name /f Date(month,day,yea)
- r/�/t/f=ull resident address of applicant(number and street,cry,state,and ZIP code)
1�\f�` ( /Jde 3r;O A vE PZrv€e hie.., TrJ W767V
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,yea)
Address of authorized person (number and fleet,city:state,and ZIP code)