HomeMy WebLinkAboutMortgage_Neufelder (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTFPN County Township Year
beFOR DEDUCTION FROM ASSESSED VAL T
Slate Form 03709(R71/a-09)
Prescribed by Department of Lacal Govemmen Finance
2015 He Mark
INSTRUCTIONS: - - - -
MAR Form filed with:
To be filed in person or by mail with the County Auditor or County Recorder of the county where the prod- r = orated.
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought A al County Auditor
2)Mobile/Manufactured Homes not as cresed as Real Property Must 7=-du " r'41 :r.-,(
before March 31 of each year the deduction is sought I.CQUNTY AUb'�{®wths
❑ County Recorder
�SAepe reverse side for additwnal instructions and qualifications. 6(99011
//f ((1// 2 6 see r�.wr imsm sal ) i
Taxing District Key desorption Record number rd numb Pa
a4, _ 9-'9-191 000t3-4,7 - 62-3 /5 y/
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is dire app6ont the sole
March 1,-wren year March 1,cu qt year n data of application legal or equitable owner?
5 -1 ❑ Yes 0 N
If no,what's his/her erect share of interest? �i If owned with someone other than spouse,Indicate with whom
If name on record's different than that of appGmnt,Indicate below. Is the property in question:Annually Assessed
Real Property ❑Annually Assessed
• Mobile Home(IC 61.1-7)
Name of mortgagee or contract seller cl
Address of mortgagee or contract seller(number and street, ' stare,and ZIP code) (Ul(^f, n
Name of assignee or other owner or holder of mortgage
-
Address of assignee(number and street,city,state,and ZIP_aodel -
��...1y�,� L. !Se"L��e"�kew,
Does applicant own property in any other 1 '—x-0.5 \ \ Has this deduction been requested on property
country in Indiana? ❑ No Y`Y`J 1 1 1 e_ ��-�1 o Wy-� tJlr for current year? ❑ Yes ❑ No
ki❑ Yes \\ '//) '�
Deduction approved in the amount of: • a ✓ 17
20 20 , 20 20
7..SU
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/contract buyer of the aforementioned property on date application is filed.
SlgreNre owners name Date(month,day,}rear)
F ...cif,number and sheet,city,statp.and code) �7 "
Dc 3/i5 S 'airz. `f -, 'C-D/1a/rL�l J 317Z,- 1Sf
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,state,and ZIP code) .