HomeMy WebLinkAboutMortgage_Brooks (2) - �.�a;�_� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Count ithit: r •
FOR DEDUCTION FROM ASSESSED VALUATION
li-Cns,:J State Form 43709(R11/g-09)
""- Prescribed by Department of Lod Government Finance
File ark
INSTRUCTIONS: - I) .
Form illt with:
To be tiled in person or by mail with the CountyAuditor or County Recorder of the county where the properly is located.
Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought un ; di
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months , r, 1 •t
before March 31 of each year the deduction is sought GIBS N C t I Dr7R±r , er•
See reverse side for additional instructions and qualifications. -
or contract buyer-se'e re/.sfjirmns on rse side)
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T ,nr Disbici numbr? al desolation Record number Page number
40ntSv)I /f -/poi�ao. 3S2- act 0.7o/s /0.57
Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract" unpaid as of R the apptratt the sole
March 1:=rent year March 1,atrtent year date of apprxation /( le gal a equitable awne
d/.°61 El Yes El N No
If no,what is his/her axed sham of interest? If awned with someone other than spouse,indicate with whom
If name on record is different than that of app&ant indicate below Is th property in question:Annually Assessed
Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller e
Address of mortgagee or contract seller(number street city:state.and ZIP code)
Name of assignee or oho owner or holder of mortgage
Address of assignee(number and street dry,state,and ZIP code) $ /
Yt 3 -i • S:ana
Does applicant own property in any other� ,,.../ If yes,what county? . What Taxing District? I Has this deduction been requested on property
county in Indiana? 'QC I. I for aurent year?I7 Wm w._ ❑ Yes ❑ No
IVY( WUAG.I 6 COUNTY AUDITOR
15.— 105( 20 20 20 20
County Date(month,day,year)
.. ..___._., _..__. _._r_.._- _. _._._._---o,ti foregoing information is toe and correct and that the applicant is a resident of Indiana and
Amer/contract buyer of the aforementioned property on date application is filed. .
Signature(pwner'D full name) -- Date(month,day,year)
�rZhf;. �0X---c-Th
Fu,v�;resident address f apprxant(number and street oily,state,and P code)
X ` O5 Not_1 hthirrl'L� rEck �nbnx 1 I
Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authored person (number and street,city,state,and ZIP code)