HomeMy WebLinkAboutMortgage_Richter a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Year
bra; FOR DEDUCTION FROM ASSESSED VALUATION
State Fenn 43709(R11/6-09)
Presmbed by Department of local Government Fierce
Pile Ma
INSTRUCTIONS: MA i
Tb be tiled in person or by mail with the County Auditor or County Recorder of the county where the property lyt
Pe Y ty N ty P Perty'is located.
Firing Dates: 1) Real Property.Must file during the year for which the deduction is sought ' • • • ,rtor
2) Mobile/Manufactured Homes not assessed as Real Properly Must file during the twelve(12)months ' •J.7.- -el rtly Rerord�
before March 31 of each year the deduction is sought - UpITUK
See reverse side for additional instructions and qualifications. GIBSON L e -
... — owner or contract buyer-see restn
•• r>sm �e) /J •
Teri•• .' :'.• / `P/1(ey number/legal description 7/`'-' Record number Page number
• • r) 6- 22 - /5 - 300- 000. 377 - 0�y 2,,0 lc Si ?
• y-u value areal property as of Mortgage I Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the applicant the sole
: • 1;oaten year March 1,current year data of application legal or equitable owner?
0IDD 0 Yes 0 No
If no,what is his/her exact share of interest? If owned with someone aria than spouse,indicate with whom
If name on record is afferent than that of applicant indicate below Is the property in question:Annually Assessed
❑Real Property ❑AnnualyAssessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller F �,-/`" _ - �) — -
Address of mortgagee or contract seller(number and save cdy,state,and ZIP code) • /O (�
Name of assignee or other owner or holder of mortgage Drawer N O rte/'!\ —
Address f assignee(number and street,city:state,and ZIP code) t li
. fit Sf-o Sec) 1 $ 4 // ILIAC Card NO. ...."7
roes applicant ndnre? property in any other If yes,what county? - What Taring L. ..... Ica ens on been requested on property
ty ❑ Yes ❑ No I� ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the arnount of:
200 20 20 20 20 20 20
Si ra/ of County Auditor County Date(month,day,year)
I I We certify under a penalty of perjury 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.
k_Sigrature rh/u➢name) Gf Date(month,day,year)
, r
tePull resident address of applicant(number and atree; sate and ZIP pole
�&a€ 1,r/ S %ut sfadf /A2 V740
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,cry,state,and ZIP code) .