HomeMy WebLinkAboutMortgage_Appman 1
... STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
a� '`� FOR DEDUCTION FROM ASSESSED VALUATION
� �] State Form 43709(R1I/6-09)
•� -.f/''� Presafbed by Department of ICI Government Finance ■ :_. :
File Mark
INSTRUCTIONS: - rrt1 �Q1C filed with:
To be tiled in person or by mail with the County Auditor or County Recorder of the county where the prop Ilat with:
Ring Dates: 1) Real Property.Must file during the year for which the deduction is sought .In' County Auditor
2)Mobile/Manufactured Homes not assessed as Real Property.Must file during the twelve 12)mon el
before March 31 of each year the deduction is sought -'mm�r ❑ County Recorder
See reverse side for additional instructions and qualifications. G(BOO�rOUNTY ALOtTOR
AppOrenl(owner or buyer-see on r(e'v,erse side) /�M /�"/ q/)^)•
Taring Key /legal description Record number Page number
zlo- �,3 oQ - y/1600� 8�/ oar{ zoiy aic
P rdlue of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage/Contact Indebtedness unpaid as of Is the appfmant the sale
:anent year March 1,anent year date of aPPOcotion legal a spoilable amen
� a57UG • ❑ Yes 0 N
If no,what Is his/her exact share of Interest? If owned with someone other than space,indicate with whom
If name on record is different Nan that of applicant Indicate below. Is property in question:AnnualyA,sessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of nnrgag��tract se er % / •
re
Addss of or contract seller(number and street, ,and ZIP code)
Name of assignee or other owner or holder of mortgage i‘-O' 't 1_. �'Lt __
Address of assignee(number and street,city,stare.and LP code) J OS C p v� �, T�
DI awer i\r °I(J�t ie-A C.
Dees applicant own property in any other If yes,what county? • What' -t o Q 1 P` 4" •. erty
county in Indiana? ECG.
❑ Yes ❑ No Card NO. v - y... : No
COUNTY AUDI..... S-n-c9
Deduction approved in the amount of:
20 20 20 20 20 20 20
Sgnahse of County Auditor • County Date(month,day,year)
I 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
Amer I contract buyer of the aforementioned property on date application is filed. .
Sig ) Date(month,day,year)
F/yW�revq/5d ga -(nuOar— Zic satEs4--c YC.S '7 'cU.(iJ.S&ZGf/1 `I7639 .
P rerson authorized by duty executed Power of Attorney et by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,d4 state,and ZIP cods)