HomeMy WebLinkAboutMortgage_Luttrell 4.4., ... STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
aS'... FOR DEDUCTION FROM ASSESSED VALUATION
"' 'J State Form 43709
/
Fresco-bed by DeParrtrnent of Local Government Fuarrs IF LE
INSTRUCTIONS: .
Form Ned with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. C C (��
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought E� C2Ml 5\editor
2) Mobile/Manufactured Homes not aTwssed as Real Properly Must file during the twelve(12)months
before March 31 of each year the deduction is sought /)r Cou Roman
See reverse side for addttionalinstructions and qualifications. GIBSON CODIvTr AUDIfOR
AppAtlnl(op uyeJ m re Ee)
e/�_
Key number/ lion Record number Page •
�/1.aano Z/o—/9 -/S- /O / -Qtr/. /tali -Or /5 dV9
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sale
Mardi 1,,anent year March 1,anent year date of application legal or equitable owner?
/a/300 0 Yes 0 N
If no,what is his I her end share of interest? If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant,Indicate below. Is the property in question:Annually Assessed
❑Real Property ❑AnnualyAssessed
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Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller �/cp •
Address of mortgagee or contract setter(number and sheet,city state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city.state,and ZIP code) /� y�(1 '
Does appferant own property in any other If yes,what county? • I Wha'T - / j y i►, /, • r property
county m Indiana? n �� yQ U/N�
❑ Yes ❑ No l • IL �,�((�� da"-AI Q ❑ No
COUNTY A �Vll 'W°/5 9q r
Deduction approved in the amount of. • iVi._
20 20 20 20 .0
Signature of County-AC - Cow Data(rmW,day,year)
I//yWWeeicertify� under 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 buyer of the aft,ementioned property on date application is filed.
`�Slg (owner's ND name) Date(north,day,year)
` F resident addresss a t(number a street,city,state,and ZIP code)
�C W 2/0Z eA/Ctasacc) br. Ail tancA LM V76 Yf .
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day.year)
Address of authorized per son (number and street,city,state.and ZIP code) .