HomeMy WebLinkAboutMortgage_Hook 4/
STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Court T nshi Year
' FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: :. I I 1
arm 1,• .
To be filed in person or by mail with the CountyAuditor or County Recorder of the county where the property is located.
Filing Dates: 1) Real Property:Must file during the year for which the deduction is sought. C. uditor
2) Mobile/Manufactured Homes not assessed as Real Properly:Must file during the twelve(12)months
before March 31 of each year the deduction is sought. ❑ er
GIBSi• - e-
See reverse side for additional instructions and qualifications.
'• -
Appfxant(ownerpr contract - restrictions'on redaMdsey ) C ___ _ \
C/,/) /LC)J_J�J � l�--yay-vv �Dll ? 113 \
Taxing Disbpi number/legal description Record number Page number
/..emi If aco-/g- -Z7-9a610o a=339 —off_
Assessed valued real property of Marfgage/Contract indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as d Is the appbc nt the sole
March 1,anent year mh 1I gf.�.� +�}Y� date of aPP�tion legal a equitade owneR
I
! / V ❑ Yes ❑ No
no,what Is /her exact share of interest? Ov If owned with someone other than spouse,indicate with whom
It name on record is different than that of applicant.indicate below: Is the property in question:Annually Assessed
❑Real Property ❑Annually Pressed
Name of Mobile Home QC 6-1.1-7)
mortgagee or contract seller �
/caeei? y/ �-• YY)arise `-- -traci Intaliq
Address of mortgagee or contract seller(number and street,cey,state,and ZIP code)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,ary..state,and ZIP rode)
f
Dees applicant own property in any oth•M If yes.what county? What Taxing District? Has this deduction been requested on properly
county in Indiana? for current yeah
❑ NO
❑ yes, El Yes ❑ No I - -
UDROR
Deduction in the amount at
20 20 20 20 20 20 20
signature er svunty Auditor County Date(month,day,year)
I/vVe 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/contract buyer of e aforementioned property on date application is filed.
et Sig oarners MI name I Data(month,day,Year)
>_ till resident address of... (number and street,ray,state,and corle)
e XoZ88(Q 405 FS- fro At c/z</7
Person authorized by d - eased Power of Attorney or by IC 6-1.1-12-0.7 Date(month,dry,year)
Address of authorized person (number and street,city,state,and ZIP code) .