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HomeMy WebLinkAboutMortgage_Leibel STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year ;' FOR DEDUCTION FROM ASSESSED VALUATION It State Form 43709(R11/6-09) FILED Pnsoibed by Department d Local Government Fuunce INSTRUCTIONS: . To be filed in person or mail with the County Auditor or County Recorder of the county where the property Form filed with: P by ty ry ty P Pert'is leafed. Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought APR 1 r an Ibounry Auditor 2) Mobile/Manufactured Homes not acrssed as Real Property:Must file during the twelve(12)months before March 31 of each year the deductions sought - ❑ County Recorder See reverse side for additional instructions and qualifications. r47L.�-Y Appuam(o(owner or cataract buyer-see on re side) Gib CODUN7TY�"q��UDITOR T D •`CSnumber/legal description O O/• O �•••� Record number :Number umber .�+ all - /4-/s_ la/ - /Y9 - I Assessed value dread property as of Mortgage/Contract Indebtedness unpaid as of Mortgage I Contact indebtedness unpaid as of Is the applicant ie sole March 1;asmtt year March 1,current year date of application legal or equitable owner? .ZID QO ° El Yes 0 N If no,what is his/her exact share of interest? If owned-with someone tither than spouse,indicate with whom If name on record is different than that of applicant,Indicate belovr. Is the property in question:Annually Assessed ❑Real Property ❑Annually Assessed Mobile I-tome(IC 61.1-7) Name of mortgagee or contract seller Address of mortgagee or contract seller(number and sheet,city,state,and ZIP code) Name of assignee or other owner or holder of mortgage Address o assignee(number and street,city,state,and ZIP n / Does applicant own property in Omer If yes,what county? • What Taxing r Has this deduction been requested on property minty in Indiana? for awrem yeah ❑ Yes 0 No ❑ Yes ❑ No COUNTY AUDITOR Deduction approved in the amount of: . 20 20 20 20 20 20 20 Signature rC ly Auditor., ` County - -- _ I Date(month,day,year) '�>tro`Tu. p. Lei�1 I/We certify under the penalty of perjury that the above and foregoing information is to v,/CS CY'n `� j i owner I contract buyer of the aforementioned property on date application is filed. `�. G Drawer r rraNre(owners fxr0 name) j�O,�................ EGA � -Qr a°1 ks % l V I resident of applicant(number and street,aTy,state,and ZIP code) r7 Ca 1 (] �_ %(- I J d Q l� C k w. riSCLw -Jr 1-7.�rMCh j kJ ink-14( No e't Person authorized by duly executed Power of Aubmey or by IC 6-1.1-12-0.r7 ^a 1 o I 600. pc • Address of authorized person (number and street,city,state,end ZIP code) .