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HomeMy WebLinkAboutMortgage_Glaser - 'q, STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township YYar , ;,' i ^ FOR DEDUCTION FROM ASSESSED VALUATION j- - yel ���r State Form 43709(Rii/6-09) a' „ems, Prescribed by Department of Local Government Financetoi 0o File Mark �TRUCTIONS: ip Form filed with: be filed in person or by mail with the County Auditor or County Recorder of the county where tlgi@r islufted. Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. JJ ❑"County Auditor 2)Mobile/Manufactured Homes not assessed as Real Property:Must file during the twelve(12)months before March 31 of each year the deduction is sought. El County Recorder See rever a side for.dditional instructions and quali tions. GIBSn Applica ..,•.'•rco ctbuyer 'tee restri son ve e$ ) N UNrYA rpFZ Taxi i Key n. er/le al description Re num r Page number �- JIL�x e�- ' (P-1 Q-1$ -1 o I-0c0. 14.o S -O 38 Assessed value of real property as of Mortgage/Con indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole March 1,current year March 1,cu date of application legal or equitable owner? PM El Yes ❑ No If no,what is his/her exact share of interest? l 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:Annually Assessed D Real Property ❑Annually Assessed • Mobile Home(IC 6-1.1-7) Name of mortgagee or contract seller .....40.1)3,1"- f-1/42nAkt Address of mortgagee or contract seller(number and street,city,state,and ZIP code) Name of assignee or other owner or holder of mortgage Address of assignee(number and street,city,state,and ZIP code) Does applicant own property in any other _I If yes,what.i-'unty? • What Taxing District? Has this deduction been requested on property county in Indiana? p for current year? ❑ Yes 0 No 1110— a0/ Drawer N0. ...„,,....+. COUNTY AUDITOR Dedi Card NO• ••SIM3•••• 20 20 20 20 Signa I 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/lcontract buyer of the aforementioned property on date application is filed. Signatur (owners full name) iy Date(month,day,year) tullesident address of applicant(number and street,city,state,and ZIP code) 7©y Eacl /Pay/.( Srr8EY !-0`7 h '/ 9'i9{ ch ZN 1-/7 ( Person 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)