HomeMy WebLinkAboutMortgage_Bensonia� �� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
� FOR DEDUCTION FROM ASSESSED VALUATION Count Township Year
«. y State Fortn 43709 (R6l 5061 ���
� Presaibed by Department of Local Gwemmeni Finance
INSTRUCTIONS: M�� j�a�ZUOd
To be filed in person o� by mail with the CountyAuditor of the county where the property is located.
Filing Dates: 1J Rea/ Property: Dunng lhe 12 months 6efoie ,lune � 1 0/ the year the deductlon is to be e(fective.��Ia� ,Q��+!°�
2) Mobile Homes assessed under IC 6-1.1-7: Befween January 15 and March 2 0l the yeai t�e�kc�o�UNiY AUDITOR e
See reverse side for additional instnictions and qualifications.
Applica ownerorcontract buyer- see ctlons on reverse side)
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Taxing Districf Key number / legal description Record number
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Assessed value of real property as of MoAgage / ContreC indebiedness unpaid as of Is the applicant the sole legal or equitable
March 1, cuneni year March 1, current year owneR �Yes ❑ No
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If no, what is his / her exact share of interest? f owned wilh someone other than spouse, indicate with whom.
If name on record is different than that of applicant, indicate below: Is the property in question:
Property ❑ Mobile Hame QC 61.1-�
�e of mortgag e r contraQ seller
Address of mortgagee or contrad Iler (number and street, city, state-��P __
Name of assignee or other owner or holder of mortgage Dra�ve� 1\T�'.. �(L.�J7: •'
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Address of assignee (number and stieet, city, state, ZIP code) Ca rd 1�Q �3J 9
............ . ._
Dces applipnt own property in any other If yes, what county? vv��a� � a,.,.. �����$ � ys n re uesled on
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county in Indiana? property for currem yeaR� Yes� No
COUNTY AUDITOR
Dedudion approved in the amount ot:
20 � 9 20 �Q� 20 20 20 20' 20
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Signature County Auditor Date
We certify under the penalty of perjury that the above and foregoing infortnation is true and corred and that ihe applicants was / were
eside of Indiana and owner of the aforementioned property on March 1, 20
Sig ure ners 11 na Person authorized by duly executed Power of Attomey
�, or by IC 6-1.1-12-.07
Full resi nt address of applipnt Address of authorized person
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