HomeMy WebLinkAboutMortgage_Donaway'y�► STATEMENT OF MORTGAGE OR CONTRACT iNDEBTEDN ou ownship Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R11 / 6-09)
�' ,,,� prescribed by Department of Local Govemment Fnance
�pTRUCTIONS:
JAN 2 5�2013 File Mark
Fortn filed with:
To be filed in person or by maii with ihe CountyAuditor or County Recorder oi the county where ihe property is Iocated.
Filing Dates: 1) Rea! Property: Must file during the year for whieh the deduction is sought. • � County Auditor
2) Mo6ile / Manufactured Homes not assessed as Real Praperty: Must file during the (we i
before March 31 o€each yearthe deducfion is sought. , A DI�RCounty Recorder
C SON COUNTY
See reverse side for additional instructfons and qualifications.
Aooliranf (owner tract 6uver - resUictions on reverse side r7 .. n %i D
Key number /
_� �__,
Assessed value of real property es of
Merch 1, Cxrentyear
If no, what Is his / her exact share of interesY?
MortgagelContrac£ir
March 1, current yeer
If name on record is difrerent than that of applicant, indiqte below:
Name of
� Reco ny�ber Page number
6�� -oa� %
unpaid as of Mortgage / Contract indebtedness unpaid as of Is the applicaM the sole
date of appiication legal or equitable ownerJ
� Yes ❑ No
Address of mortgagee or contract selled(ny(m6er and street, city, state, and ZIP code)
Name of assignee or other owner or holder of mprtgage
Address of assignee (number and sfreet city, state, and ZIP code)
Does applicant own property in any other
county in Indiana?
Q Yes _
Deduction approved in the amount of:
20
Signature of County Auditor
I If yes, what countyl
No
couNnr
If awned with someone other ihan spouse, indicate with whom
the property in question: Mnually Assessed
�eal Property ❑ ArmuallyAssessed
Mobile Home (IC 6-1.
{� .
;. ... .2 �Y Dc.0 IU�4 w�
ims'i� � A tc.�R-s
13-Lf��
20 � 20 � 20 � 2U
County
20
Date (month, daY. Yea�
� P��'�Y
❑ No
20
I/ We certify under the penatty of perjury that the above and foregoing information is Vue and corred and that the applicant is a resident of Indiana and
owner / contrad buye� of the aforementioned property on date application is filed.
�nature� rs full name) Date (m9nth, da'; yea�
n � n.. � �
and street city,
�i i vf. ►v � �,rr�sra.� u�v� v�. i► u��
Person authorized by duly executed Power of Attomey or by IC 6-1.1-12-0.7
Address of authorizEd person (number and streek city, state, and ZIP code)
Date (month, day, year�