HomeMy WebLinkAboutMortgage_Penner (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTE LW '�:, 1.11}' r Township Year
LeFOR DEDUCTION FROM ASSESSED VALUATION 't
State Form 43709(Rile/6-09) -
Presaibed by Department of Loral Dovernment Finance
■i ' File Mark
INSTRUCTIONS:
A •1 Fonn filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the pmpe its 1..-:.yi 11111#t
Filing Dates: 1) Real Properly:Must fie during the year for which the deduction is sought. I I ' UT AUDI County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the tw - lgjelo it
before March 31 of each year the deduction is sought - C18b. County Recorder
See reverse side for additional instructions and qualifications.
Vtt(ownermmntract buyer-see r/e�sbictio on reverse e)
O)7l 9)u-Q- 1/. ns J9 li2/1lL/cJ
T Key number/legal description Record number Page number
nimritlYn Flo-// - kg .ao3 i Fry d# 2 K /y it 81/ 7
Assessed value of real property as of Mort gage/Contrail indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
March i..carrot year Marc rre0t ye 60 date of application �N Q Yes ❑ oN
•If no,what is his/her exact share of interest? ✓'(�.//( If owned with someone other than spouse,indicate with whom
If name on record is 6fferrrn than that of applicant.indicate below Is the property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Horne QC 6-1.1-7)
Name of mortgagee or contract selleyr, I -D
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and sbee4 MIX slate,and ZIP code) - -- - - J yy—y -
Does appfKant own property in any other If yes,what county? • What PI.QAI \ W
0/' /'�-A-a�7 D terry
county In Indana? ❑ Yes ❑ No
1\1\4.. 7 No
P.e,IY)lc..t ia-�v l7
COUNTY AUDI I' n
Deduction approved in the amount of: - ICI— 4 BY /
20 20 20 20 20 1 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
owner Iffcontact buyer of the aforementioned property on date application is filed.
Signawte jo4marY MI name) !', �n� Date(mouth.day,year)
Fu t // `u,m/erberaaannd beet,�:stay ZIP code) n
Oc' '0r R IAA- ,tom / - l/�u cCr> 11767o
Person authorized by duty executed Power of Attorney or by IC 6.1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,dry,state,and ZIP code) .