HomeMy WebLinkAboutMortgage_New Generation Dairy Inc Ate . STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
AVM FOR DEDUCTION FROM ASSESSED VALUATION
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4.R State Forth 43709(R11/6-09)
S w f Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: .
To be filed N person or by mad with the Co Auditor or County Recorder of the county where the d Pe Y untY h h Property is local Fling Dates: 1) Real Property:Must file during the year for which the deduction is sought d(tor
2) Mobile/Manufactured Homes Trot assessed as Real Property Must tle during the twelve(12)months I��''�I �0yp1y before March 31 of each year the deduction is sought it
B k-1i /U lh Recorder
See reverse side for additional instructions and qualifications. 4u �� /ll I'1
APPraant(• contact buyer-- - on re .,side).
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Taxing D' ti nurnber I �aT /OD - Do I. 4.15-oat � :. Y -
Assessed value of real property as of Mortgage ea Contract indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the app tt Ne sole
March 1:coral year yrarO�a date of aPP� legal o�itable O
3 Yes No
If no,what is his/her exact share of interest? If owned with someone other than yn,m,indicate with whom
If name on record is deferent than that of appl/a�nf,Indicate below. Is the property in question:Annually Assessed
w"r,\ 1 ❑Real Property ❑Mobile 6
(�(� Mobile Annually Assessed 6-1.1-7)
Name of mortgagee or contract seller
Address of mortgagee or contract seller(number and street,city,state,and ZIP code)
Name of assignee or other owner or holder of i. .gage
Address of assignee(number and street,city,state,and ZIP cede)
Does applicant own property in any other If ya-ntst ",en_... —. �. I wr..'.en�..J:.•,�.,rv.r,:,.e I Flan this deduction been requested on property
county m Indiana? ❑ Yes ❑ No I �I :11\'C 1 1�U:.0C 1/� rent year?
5 ❑ Yes ❑ No
Deduction approved in the amount of •
Card \t O. —.835
4iay 3iry� oo
20 20 20 l .... 1 CU - ' ZO 20
Signature of County Auditor County Date(month,day,year)
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(owner's AA name) Date(math,day,year)
Full resident address of applcant(number and street u7y,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(mordh,day,year)
Address of authored person (number and steel,city,state,end LP code) .