HomeMy WebLinkAboutMortgage_Fish (2) '''''<i" FOR STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 03709(R11/609)
Presaibed by Departmerd of Lod Government Fnarce
ark
IT
INSTRUCTIONS:ed in person N•
To be fled in person or by mail with the County Auditor or County Recorder of the county where the property is located. AAAAAA
Filing Dates: 1) Real Property Must file during the year for which the deduction is sought County D
2)Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months uf�(y
before March 31 of each year the deduction is sought. A P - ' COL U l�ernrder
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See reverse side for additional instructions and qualifications.
Appb
(owner or contact buy« restnc ns on ever side) ��
ari District Key nuu mbbbbber/legalldescription
�( dfrtlttorm�
AC, /3 -/ a loo OOH %o6 -0o4 �� r4 37, 383
valve of real property as of Abrgage/Contract indebtedness unpaid as of Mortgage I Contract i debtedness unpaid as of Is the app9rant the sole
March 1,current year
=gem/
anent year date of a prrcla�tion legal a.equitade own ?
.5� op0 0 Yes 0 No
tf 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:Mnue%Assessed
❑Real Property ❑AnnuaM Assessed
Motile Home(IC 61.1-7)
Name of mortgagee or contract seller Fc _
Address of mortgagee or contract seller(number and street city state,and ZIP code) -
aoVA-3a 33
Name of assignee or other owner or holder of mortgage ''—k
ye.'l Q'r. L. c1 t-n�. 1
Adtl of assignee(number and street cb state,end ZIP code) ` `err\�~�e'�C 1 e.:1'eki
7T SD A)Cz) IA -03 - 9 a.00 AC- • Drawer 10 s)fti. oy
• ��_ 1.1'an ty
Does applicant own property in any other If yes,what county? • What Taxing District? 01
�
county in Indiana? ❑ No Card O. 5100J . Lip:\7
❑ Yes
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signs of County Aud(tor County Date(month,day,year)
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 I contract buyer of the aforementioned property on date application is filed. .
y Signature(owner's fug name) Date(month,day,year)
J� I
/d n1PM cf.. t.Ah
Full resident address of applicant(number and street Gay,state,and LP code)
ork/'
%oO /t/, incn6. 04X/A eJC,T )1 i 411a6o0
Person authorized by duly r executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street dry,state,end ZIP code) .