HomeMy WebLinkAboutMortgage_Richeson�° STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS
' FOR DEDUCTION FROM ASSESSED VALUATION Coun Township Year
1- � State Fortn 43709 (R4 / 1P41)
yi.
� Prescribea by Department of Laal Govemmeni Finance
INSTRUCTIONS: ^�{—�' �il M�
To be filed in person or by mail with the County Auditor o! the county wheie the properiy is locat� ��
Filing Dates: 1) Real Property: During the 12 months belore May 11 of the year the deduction is be e
2) Mobile Homes assessed under IC 6-1.1-7: Between January 15 and March 31 0/ the ye� Athe deduoticLD�is to be effective.
IV �. G L�lu�
.Caa rcvarsa sirVe /nr arlrliFinnal ineln�clinne and nualifirahinnc �
. . _ . . . . . _ . _ _ . , _ . _ _ _. � .. ._1 �G�l�t
Applicant wne�orcontractbuyer-seere Mctionso revers side) . ,;1 ij; ,-.��q��OF
� � CIBSON . �-�
Tauing D ricf Key number / legal description Record number
/��LZY`.//sr, _� ��[P � QG � / � � Page number �
� �lJdlb�
Assessed value of real property as MoRgage ! Contrad indebtedness unpaid as of Is the applicant the sole legal or equitable
March 1, current year March 1, current year ownef? ❑ Yes ❑ No
QQ �
If no, what is his / her exad share of interest? If owned wiih someone other lhan spouse, indicate with whom.
If name on record is difierent than that of appliwnt, indicate below: Is the property in question:
❑ Real Properry ❑ Mobile Home pC 61.1-�
�me of mortgagee or conVact seller
Address of mortgagee ar contrad seller (number and s et, city, state, ZIP
Name of assignee or other owner or holder of mortgage
Address of assignee (number and st2et, city, s[ate, ZIP code)
Dces applipnt own property in any olher If yes, whal county? What Taxing Distrid? Has this deduclion been requested on
county in Indiana? property for current yeai'? � Yes ❑ No
COUNTY AUDITO � Z_ � /
Dedudion a roved in the amount of:
20 20 O 20 n_! 20 _� 20 �'L 20 � 20
P��� � P Q
Signature Counly Auditor Date
�/ We certify under the penalty af perjury that the above and foregoing infortnaHon is true and corred and ihat the applicants was / were
��.resident of Indiana and owner of the aforementioned property on March 1 i�0
i nat ( er full name) . .Person authorized by duly executed Power of Attomey
or by IC 6-1.1-12-.07 �
esident address of applip t Address of authorized person
�8 �. ton�