HomeMy WebLinkAboutMortgage_Booker (2) M�a_ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
� y State Form 43709(R71/e-09)
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Prescribed M Department or tad Goremmene Finance F I I��
INSTRUCTIONS: `M�l� .
To be filed hi person or by mail with the County Auditor or County Recorder of the county where the property is located. F.
tll r 4 2015
Filing Dates: t) Real Property.Must file during the year for which the deduction is sought 1 County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must Re during the twelve(12)months
before March 31 of each year the deduction is sought - Ilf Cou, Ryas-
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See reverse side for additional instructions a ualifrccatiss//dy�nees. //J� d/�^/ /, L GIASnN COUNTY AUDITOR
AP..,� ../2a. ar°e V/7 C) / / OoPi_..e.
i • Key number/legal description •.....number Pag
� • _. _ . — , a• - .. .i— oat , o 5l 1 '�/
Assessed value of real property as• Mortgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
March 1:current war Mardi 1,anent year data of application ""�� legal or equitable owner?
ay�/ oda 0 Yes 0 No
If no,what is his/her exact sham of interest? If owned with someone other than sprnicn,indicate with whom
If name on record is different than that of applicant,indicate below. Is property in question:Annually Assessed
Real Property ❑AnnuafyAssrssed
L £ - e/ op
Mobile Home(IC 6-1.1-7)
Name of mortgagee or canted seller /
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Address of mortgagee or contract seller(number and street city.state. code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street.dty state.and�ZIIP code) .
Does in Indiana? property in any J r r( I! ���/! _ n� t? Has Na deduction been requested on property
county in lMaa? `� i- ,x1F'J'Y`1%/ for current year? ❑ Yes ❑ No
❑ Yet
Deduction approved In the amount r 0 ;Cote A
20 20 f( � cC 20 20
Signature of County mentor / /' Date(month,day,year)
II We certify under the penal ��`�\ ��'`� nrrect and that the applicant is a resident of Indiana and
owner 1 contract buyer of the
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Signature(gums Tull name) I G Date(month,day,year)
1\\ ,'��1 1,\! 1
Full resident address app n 1
(9756-4 E . a sQ I ,5_,014 A. p
Person authorized by duly executed � ' Date(midi y,year)
Address of authorized person (number and street city,state,and ZIP code)
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