HomeMy WebLinkAboutMortgage_Brinkley „,sue STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
" ` hip_ FOR DEDUCTION FROM ASSESSED VALUATION 1 f, ,.�
State Form 43709(R13 I 10-15) //�\1` C,,/1 2-�D
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,_,f Prescribed by Department of Local Government Finance INSTRUCTIONS: _
County Auditor
located on or before January 5 of the immediately succeeding calendar year. County Recorder
2) Mobile/Manufactured Homes not assessed as Real Property:Must file with the County Auditor of the county
where the property is located during the twelve(12)months before March 31 of each year the deduction is sought
See reverse side for additional instructions and qualifications.
Applicant owner or contract buyer- strictionsonreverseside)
owner
se, t �n iC,
Taxingrs K n tuber!1 a lion Record number Page number
fig - n-202-0 00 uC1r—df--4 20 20 02_03
Assessil value of rel property as of Mortgage/Contract indebtedness unpaid as of Mortgage 1 Contract indebtedness unpaid as of Is the applicant the sole
assessment date,current year assessment date,current year date of plication to legal or sty. ble owner?
J UNve . — , ](Yes ❑ No
If no,what is his 1 her exact share of interest? If owned with so eone er thanpouse,indicate with whom r'\
If name on record is differentthan that of applicant,indicate below: Is property in question:Annually Assessed
Real Property 0 Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of a ee or contract sell
a` 1 li
Address of mort agee or contract seller(number and street;city,state,and ZIP code) ;
Name of assignr ---``—
,ZO c,/-v _ 0 0 3 AAA 1i Zap
Address of assig de) /Does applicant c • What Taxing District? Has this qij 1 Q yQ
es,state amount of deduction
other county on pro r
in Indiana? D r a IN'C I' NO c . C es ❑No
-
A person is not on has a balance on the person's mortgage or contract indebtedness that is recorded in the county
recorder's offici t that is recorded in the county recorder's office)that is the basis for the deduction.
Card NO COUNTY AUDITOR
Deduction approved in the amount of.
•
20 1.'0 20 20 20 ' 20• 20
Signature of County Audit,+ * czp, County Date(month,day,veer)
I/We certify under- information
penalty of perjury tha a and foregoing infoation 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.
/\Si9nature77 /v l Date(month,day,year)
lit E 0.71.02,
Full r d d pl” t(number and t,city,state,and ZIP code)
erson authorized by duly executed 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)
Thn nanalliac farnarinni ran Innh,rla imnricnnmant fin in Iwo anti a half u ar_e and a fins not in arnanrl tin Inn