HomeMy WebLinkAboutMortgage_Elpers (10) F.%
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun jy!liME(IINI;Q;;
�;: FOR DEDUCTION FROM ASSESSED VALUATION I i r ;/%
,7'..';a2 Slue Form 43709(R11/6-09)
Prescribed by Department of local Government Finance
I *4rk 2015
INS7RUC77ONS: Form filed with:
b be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought ditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)month&IBSUN
UPU
before March 31 of each year the deduction is sought - + R4P OR
See reverse side for additional instructions and qualifications.
App&mnt(owner
r�or contact buyer-see reptz tors on reverse side) (((..���t
V L _A-C—tr. Iv 3 ��
(�g9 DismC _p )fey number/legal description "`� Record number Page number
`lam. a.L— R —% 1 -334 - Qaa: 1 - 0LI a 5 -1D`k
Assessed value of real pr perty as of Mortgage/Contract Indebtedness unpaid as of Mortgage/Contact indebtedness unpaid as of Is the applicant the sole
March i;and year March 1,current year T date of application legal�/or reequiuiitttaaable owner?
If no,what's his/her erns share of interest? D O vlf owned with someone other than spoise,indicate with whom
\ ❑ No
If name on record is different than that of attestant.Indicate below. Is the property in question:Annually Assessed
sal Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
•
Name of1f{' 9a9ee or contract seller
Address mortgagee mortgagee or contract seller(number and steel,city:state,and ZIP code) _ _ _ _
-
Name of assignee or other owner or holder of mortgage (l r� _„ _
Address of assignee(number and street cloy:state,and ZIP code) J �f1.(}/,r �D��`f Y 1➢--T
Does applicant own property in any other If yes,what county/ • What Taring D'atn V��
co />,�
unty in Indiana? ' lJ
❑ Yeso _
\\\ COUNTY AUDITOR
Deduction approved in the amount of. .
20 20 20 20 20 20 20
Signature of County Auditor County Date(mouth 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.
ton. - owners full namee)) C /� Data(month,day,year)
I residen -!� of applicant(numb sbee4 alY,state,a ZIP cod
a c5i F? �i >�nyc_ f 4Q,. wA/ /7639
Person authored by duty 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,end ZIP code) .