HomeMy WebLinkAboutMortgage_Clark (3)STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS C To i Year
FOR DEDUCTION FROM ASSESSED VALUATION
State Form 43709 (R11 / 6-09)
Prescribed by Department of Local Govemment Finance
MAR 5�ie �3
INSTRUCTIONS:
Fortn filed With:
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 whieh the deduction is sought. � unty Auditor
2) Mobile / Manufactured Homes nof assessed as Real Praperty: Must fiIe during the twelve (f 2) months
6efore March 31 ofeach yearthe deductron rs sought. GIBSON OU Y�L�1"��der
See reverse side for additional instructions and qualfications.
ApplicaM (o or contract buyer - s� restrictions�r�erse side)
� - � •
Taxing Distri y number / legal d 'ption / Recorcl um Page n cer
� � �' I � f O � (/�/O' W ��
Assessed value of re.al property as of Mortgage/ ConVact indebtedness unpaid as of Mortgage / Contract indebtedness unpaid as of Is the appiicant the sole
Merch 1, axreM year March 1, current year date of appiicaGon legal or equitable owner?
� �D ❑ Yes ❑ No
If no, what is his / her exact share qf interest? If owned with sameone other than spouse, indicate with whom
If name on record is ditFerent than that of applicant, indicate below:
Name of mortgagee or contract seiler �� �^ �
V
Address of mortgagee or contract selier (num6er and street, city, state, and ZIP code)
Name of assignee or other owner or holdAr nf mortaaae
Address of assignee (number and sUeet �
Does applicant own property in any othe D I•aw et' N� . . . . . : : .� , , , , , ,
county in Indiana? ❑ •
Yes
Card NO. ... �q,,�..........
Deduction approved in the amount of: ��'��� �j
20
Signature of Counry Auditor
20 � 20 � 20
Counry
20
Is the property in question: Mnually Assessed
❑ Real Property ❑ ArmualyAssessed
Mobile Home (IC 6-1.
Has this dedudion been requested on properly
for curnent year? ❑ Yes ❑ No
20
Date (month, day, year)
20
I/ We cert'rfy 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 / uyer of the aforeme tioned property on date application is filed.
�� (owners fu name) Date (rtronth, day, yea�
Z� e� �Z66
Person , orized by duly executed Power of Attomey or by IC 61.
Address of authoriz.ed person (number and sheet, city, shate, and ZfP code)
Date (monfh, day, yea�
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