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HomeMy WebLinkAboutMortgage_Anderson (4) a STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year f= �;< FOR DEDUCTION FROM ASSESSED VALUATION - :._t State Form 43709(R11/6-09) •"e pitmen-bed by Department of Local Government Finance INSTRUCTIONS: IF az:LE To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is located. F Filing Dates: 1) Real Property.Must file during the year for which the deduction is sought. U County Auditor 2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months before March 31 of each year the deduction is sought ❑F&n&x Reny See reverse side for additional instructions and/qualfications. �� ��uU�t i1 Applicant Owner or rxvnoaC see restrictions[p�serx SQY/j,_- 'y(` GIB H r I{ T District Ray ai description Record n be b Ku 1r0 a a? -( Q'4- yO2-1T 344-CQs 1 'I l8 R Assessed value of real property as of Mortgage/Contract indebtedness unpaid as of Mortgage I Contract indebtedness unpaid as of is the applicant the sole March 1,current year March 1, year date of application legal or equitable owner? C©1 6SID 0 Yes 0 No lino,what Is his/her exact share of interest? 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 ❑AnnuaM Assessed Mobile Home(IC 61.1-7) Name of mortgagee or contract seller /1 street Address of mortgagee or contract seller(number and street`ci y,state,and ZIP code) - Name of assignee or other owner or holder of mortgage Address of assignee(number and street r••-•-s----a'''- - - - -- . Does applicant arm properly in any other I f NI)62--- ui -2 Has this deduction been requested on property county in Indiana? ❑ Yes for anent year? ❑ Yes ❑ No 4 /3= i SO Deduction approved In the amount of 20_ 20_ I _ I �., I _,. 20 20 Signature of County Auditor County Data(month,day,year) I/We certify under the penalty of.-rju that the above and foregoing information is true and correct and that the applicant is a resident of Indiana and owner I contract buyer of the a :•'-'I e yd. ed property on date application is filed. Si. iii_osi.wnerts MI nna �ny,/(//9 rJ Date(month,day,you) crrev""i /1• /r.A }1�1���od `( � �,s L R Fa,ot6�ofas t( s.4.J�state. { — !!Yl V�v\ �� V�c/ . - _ Person authorized by duly executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year) Address of authorized person (number and street coy,state,and ZIP code) .