HomeMy WebLinkAboutMortgage_Rainbolt STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
'.a STATEMENT
DEDUCTION FROM ASSESSED VALUATION
State Form 43709(RU/6-09) t �.1i1
Prescribed by Departmerd of Local Government Finance 'a
i (.. File Mark
INSTRUCTIONS: .
ib t oialle15 Farm with:To be filed in person or by mail with the County Auditor or County Recorder of the county where the
Filing 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 7/�Yr'^'Y"""' County Recorder
See reverse side dcnal instr ctions and lifcations. I.
AppGUnl(ownerar buyer side) j G16SON COUNTY AUDITOR
Veltlegpdesyrtgon_ Record P' ,1,f►t.0 — &CR-ot33��....0 a2 rr �b
A value of real property as of Mortgage/Contract Indebtedness unpaid Mortgage/Conuact'uWebtednes.unpaid as of M the appfirant the sole
March 1;end year March 1,current yearning 5 ,D date of appGraticn legal ❑ fable❑
J OyJ Yes No
If no,what is his/her exact share of interest? If owned with someone other than spouse,Indicate with whom
If name an record is different than that of applicant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑AnnuallyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller c _ r I c 9 r r
Address of mortgagee or contract seller(number end street,/city,state,and ZIP code)
Name of assignee or other owner or holder of mortgage (�_ �- _ . ei
Address of assignee(number and street,x10:state,an Cfra LF+r ta•E F D.
4 602.00. _
Does applicant own property in any other s this deduction been requested on property
mucdyp Indiana? °°15.••••.
❑ Yes ❑ No Drawer ��......-. cement yeah ❑ Yes
❑ No
Deduction approved in the amount of • Card NO. ... .••
20 20 20 20 20 20 20
Sgnatae•r . tyAuGior , / County Date(month,day,year)
'Ai _1 / . .IISL . I
I/ e 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 buyer of the aforementioned property on date application is filed.
•nature full •) Date(month,day,year)
) oZ//it249--
Full gen of a.. ., t
411
d street ofy,stare,and ZIP cod
•- •au by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .