HomeMy WebLinkAboutMortgage_Almond"'� STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
r__., ; FOR DEDUCTION FROM ASSESSED VALUATION
Slate Fortn 43709 (R71 / 6-09)
�' �«. ° PresaiGeG by DePa�M of Loral Govemrtrent Franre
�NSTRUCTIONS:
!o be lled in person or by mail with the CountyAUtlitor w Counry Recorder of the county where the pioperty is loc�d� Z ��
Filirg Dates: 1J Real Property: Must file durirrg the year /w which the deduction is saught Counry Auditnr
2) Mo6Ae / Manu/actured Homes not assessed as Real Pmperty: Must fiie dunng the twefve (12) mwNhg
before March 37 0( each year fhe deduction is sought County Recorder
See 2verse side for additional instructions and qualilcafbns.
AppGrani(ownerorcaioaubuyer-see mreversesCe)
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Ta �' - Key rnmhel / legal tlesmption Reco�d rwm6er Page number
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Assessed vWUe d real as d ge / Contratt intle6tedness unpaitl as of Mortgage I ContraR inEebtedness unpaid az W Is Na eppfirant the sde
Marrh t, aarent yrar MarU 1, wrtent year date o( appfxalim legal or equitade wme/1
% �! 4/ 'ri. ,� � n Yes ❑ No
If no, wha[ is ha / her e�ct share of interestt
Ii rw� on recdd is dMerent Nan Nat of app6can; mdi�ate Gebvr
Name ot mort[�agee w mntraa seller
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Pddress of rtungagee or oontract se0er (num6er a s�e; ray, state,
Name o� assignee w othu owner or halder o! mortgage
Adtlress of asvgnee (number aM stree4 tlry, slate, aM ZlP mEe)
any oNer � If yes, what
somearie
Whal Tari�g Districf7
spouu,
15 Ne ProD�Y in QueSGon: MnuallyllsseSSed
i�,�eal Properiy ❑ Mnualy Assessed
� Mobile Fbrt�e (IC 6
Has Iha deEUCtian Deen �uested m prtqeny
ro� a,�� y�r. r-, .. �
COUNN AUDROR
Oeducom approved in Cie amount af:
20 20 20 20 20 � 20 20
Si9nature W Cwnh Auditw Counry Date (rtan�h. daY• Yea�
I I We certify under ihe penalry of perjury Nat Ne above and foregoing infortnation is We and corteU and Ihat Ne appli�ant is a resident of Irdiana arW
owner / mntraU buyer of the aforementioned property on date application is filed.
Si9 (owne/s fiAI name) Date (monfi. daY. Yaa�)
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Full ent atltlress o( appfrant (numDer antl stme( dry, state, aM ZIP ootle)
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Person auUprizetl by dWy ezewted PorN of AltmneY or Oy IC Gl. t-12-0.7 Date (monN. tlay, yea�
Address of authoraed persan (numDer arN SUeef, city, sCd(e, and ZIP mde) ,