HomeMy WebLinkAboutMortgage_Holzappel at STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court Township Year
. FOR DEDUCTION FROM ASSESSED VALUATION j.i'
State Form 43709(R71/6-09)
Prescribed by Department of Local Government FFinance i
File Mark
INSTRUCTIONS:
To 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
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months I' m, A ,,
before March 31 of each year the deduction is sought - I' p..
-See reverse side for additional instructions and qualifications. GIBSO - . _ . : :
App6mnl or contract buyer-see -, '.' on reverse side)) /
FT Disarl / Record number Page number
. a,6 - i9 _/8- /a!-ooD . 835 - opL4, aoI-> 137
Assessed value of real property as of Mortgage!Contract Indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of Is the appfinnt the sole
Manic 1:asr i1 year March 1.current year date of appGninn ��yy legal w equitable owne?
g Qy oo tJ ❑ 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 ❑Annually Assessed
Mobile Horne(IC 6-1.1-7)
Name of mortgagee or contract seder 5 3
Address of mortgagee or contract seller(n and street,cdy,slam,and ZIP code) - o
Name of assignee wother owner whdderof mortgage F.1-\4k—v:( QA, MpSZ�-QPe� J _
Address of assignee(nu and stree city,sae,and ZIP code) Drawer Np..��,O I S - �3-1
•Does applicant awn pro any other If 1yerrha_court/? • What Taxing District' a` 7- o_U sj
county in Indiana? ❑ Yes
Duo 1 '$ V 00
COUNTY AUDITOR
Deduction approved in the amount at
20 20 20 20 20 20 20
--
Signature of County Auditor - County Date((month,day,year)
,
I/We/We certify 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.
k. Sigre///R/ue(ownefs and era r:) Date(month,day,year)
Full resb--d au. ,., and street. state. ZIP code)
X qo5 N tier ' ! �f k ° y/v y76y�
Person authorized by duly ecuted 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) .