HomeMy WebLinkAboutMortgage_Brackett Amw-M-y4. STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
cl..t', State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
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INSTRUCTIONS: ,fin fC .
To be filed in person or by mail with the CountyAuditor or County Recorder of the county where the property is located. Form Tyr n-4 2015
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 March31 of each year the deductions sought r' Counf: :;.....--
See reverse side for additional instructions and qualifications. GI: I COUNTYAllnITOit
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-.value of real properly as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contact indebtednessccaid as of Is the applicant the sole
Marsh'Lavern year Marsh 1,current year date of ap t legal or equitable owner?
/0-a)060 ❑ Yes ❑ No
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 different than that of applicant indicate below. Is property in question:Annually Assessed
. Real Property ❑AnmfallyAssessed
��� Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller '�,r5� _
Address of mortgagee or contract seller(number and street,city,sta , ZIP code) ,//�jt,/`�Cj-/r/
Name ctassignee or other owner or holder of mortgage �% / *-// j1 '9g
Address of assignee(number and street,city,state.and ZIP code) -/�/J� //!J 7/L� Ci
[ rty? • What Taring District? Has this deduction been requested on property
r a; C IM M — S ti �_ for current year? ❑ Yes ❑ No
_ t ' 1 • COUNTY AUDROR
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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 l contract buyer of the aforementioned property on date application is filed. .
X/ (owner's full. ) Date(month.day,year)
Full t address of applicant(number and (try,state,and ZIP code)
��t1I /5 3 f w BOOS F�- gievi n/d' td .n/ 9, %S'
'W Person authorized 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,stare,and ZIP code) •