HomeMy WebLinkAboutMortgage_Frantz STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
,
edeFOR DEDUCTION FROM ASSESSED VALUATION
State Form by Department(Rm/6-09) LED
Prate Form
try 43709(Rmerd of Local Government Finance
INSTRUCTIONS:
Form filed with:
To be filed in person or by mad with the County Auditor or County Recorder of the county where the property is located. AR l 'fn1
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. AR 1 Rdd Auditor
2)Mobile/Manufactured Homes not ar•Psced as Real Property Must file during the twelve(12)months
before March 31 of each year the deductions sought ❑ County Recorder
a/
See reverse side for additional instructions and qualifications. 71 I•
Ap t(owneror contract b��Qjf(eer.-see re ions on reverse side) - " ' • • a 1 ' •UDITOR
T ' Disbict , Key/number/legal 'ption Record number Page number
Chle-see Ct 026 - /.•3 -43 - you -coo. 2 3/- 0 D.7 /5 l 92
Assessed value of real as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the appaUnt the sole
March I;cxtent year Mardi 1,cement year data of appOcatam /� legal or equitable owner?
55/ iP 0 6 ❑ 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 the property in question:Annually Assessed
❑Real Property ❑NmualyAssessed
• Mobile Home(IC 6-1.1-7)
Name of mortgagee or contrail seller l/ r _ _
Address of mortgag
Name of assignee o
Address of assignee -......„ LA 01 i
J0")Goes applicant own I teen requested on property
county in Indiana?
_ ❑ Yes ❑ No
0
0
Deduction approved I G
20 0 20
Signature of County A h,day.year)
111 We certify and r resident of Indiana and
owner/contract I
Cigna sign ( / Date(month,day,year)
J (Full • /t ofa A t(n •- and any. - —LP code)
110 S. d ve. a(sla 61 97660 -
Person authorized by duly executed Power of Attorney or by IC 61`..tr�l2-0.7 Date(month,day,year)
Address of authorized person (number and sleet,city,state,and LP code) •