HomeMy WebLinkAboutMortgage_Stock (2)'°'�► STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS Coun Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Fortn 43709 (R11 / 6-09)
,�,� prescribed by Departrnent of Local GovemmeM Fnance
�STRUCTIONS:
Form ed with:
To be filed in person or 6y mail with fhe CountyAuditor or County Recorder of the county where the property is located.
Filing Da#es: i) Real Property: Must file during the year for whieh the deduction is sought. A N �Q�i�r Auditor
2) Mo6ile / Manufactured Homes not assessed as Real Property: Must file during fhe hvelve (i2) months ❑
before Ma►eh 31 of each yearthe deduction is sought. . Coun Re er
See reverse side fior additional insfructrons and qualiications.
Applicarn i�flrner or contract buyer - see res�ic jons on rev�se side) Q
w —.
Di ct Key number / egal desaipdon
-�- 3� - a3 - D, 0�8� o0
�ed value ot r�eal property as of Mortgage! Contract inde6tedness unpaid as of Mo�qage / Contract in�
1, currerrt yeat March 1, curtent year date of applica�on w
if no, what is his / her exact share qf interest?
If name on record is difrerent than that af appliqnt, indicate below:
Name of mo�qagee or conVact seller
Address of mortgagee or contract seller
and street, cily, state, and ZIP code)
Name of assignee or other owner or hdder of mortgage
Address f assignae (number and street city, state, a' d Z!P code)
S€ 3
Does aQplicant own properry in any other If yes, what countyt
county in Indiana?
❑ Yes ❑ No
Deduction approved in the amount of:
2o I zo � zo
Signature of Co�ty Auditor ,
ff owned with someone
C.
WhatTa�dng Di:
COUNTY AUDITOR
20
Counry
Record number Page number
a
unpaid as of Is the applicant ihe sole
legal or equifaWe ownert
� ❑ Yes ❑ No
spouse, indicate with whom
Is the property in question: Mnually Assessed
CS�ei ��rtv ❑ a�,►,u�y��sea
Mobile Home pC 6-1.
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57Za,M,� H��f'�� ��Ia' ���ry
Date (month, daY. Y�ea�
1/ e certify under the penalty of pe�ury that the above and foregoing information is true and corred and that the applicant is a resident of Indiana and
own ntract buyer of the atorementioned property on date application is filed.
Sig re(o rs full name) Date (month, day, yea�
x _ _ �.��.,. �-.�
Full res�ent address of appllcant (nu r nd street crTy, sNdte, arml
s a g �� . ���� � �.
Perso� authorized by duly executed Power of Attomey or by IC fr1.1
Address of authorized person (number and shaet city, state, and ZIP crode)
Date (month, day, yee�