HomeMy WebLinkAboutMortgage_Price (2) a STATEMENT OF MORTGAGE OR CONTRACTi III3 D County Township Year
FOR DEDUCTION FROM ASSESSED VALU O
:'= = sate Form 43709(R11/6-1 ) FEB 19 2015
Prescribed by Department of local Government Finance
File Mark
INSTRUCTIONS: I f U Form bled with:
To be filed in person or by mail with the County Auditor or County Recorder of the coy •'J,:yi-..✓rr'1 0' rail
Filing Dates: 1) Real Property:Must file during the year for which the deduction,,i,s,lcl�o w'I) O11NTY A � K County Auditor
2) Mobile/Manufactured Homes not azcnsced as Real Property k T 7= • ringThe twelve(12)months
before March 31 of each year the deductions sought - County Recorder
See reverse side for additional instructions and qualifications.
(owner or contract buyw a side) 1 / //� �,,
79 1//)Key9h �n `/.#/l GCLY
/leg description Record number Page number
—: M t / a .- . - - - O_ - O C Z 5 / d._ I ao0 So
Assessed rof real property as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1;orient year March I oxrent year .....-1. date of application or equitable owner?
//e/(cis /y • ❑ Yes ❑ No
If no,what Is his/her exact share of interest? If owned with someone other than spouse,indicate with wham
If name on record is different than that of ap kant,indicate below: Is the property in question:Annually Assessed
❑Real Property ❑NuivalyAssessed
Mobile Home(IC 6-1.1-7)
Name of mopjepf contract eller
Address of mCmortgagee or contract seller(number and sweet,city,state,and ZIP code) - _
Name of assignee or Cher owner or holder of mortgage coil
Address of assignee(number and street,city,state,and ZIP code) Drawer NO
Does applcant own property in any other If yes,what county? n requested on property
ar se m Indiana? ❑ Yes ❑ No Card NO. Ill......(_,_� J ❑ Yes ❑ No
Deduction approved in the amount at •
20 20 20 20 20 20 20
Signature of County Auditor 4 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 I contract buyer of the aforementioned property on date application is filed.
Signature(o/�rgre/s h>fl nap+p) Date(month,day,year)
•
Full resident address offapplicant(number and sCtre1et,ely state,end ZIP code) 1 t41(01-11
got JoJ3ln �lrtiw� )Tr eei- i..pr 'Brawcry ;IN
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 I
riz Date(month,day,year)
Address of authorized person (number and street,city,state.and ZIP code)