HomeMy WebLinkAboutMortgage_Fulling f� . STATEMENT OF MORTGAGE OR CONTRACT INDEBTE t1_, jj County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION E
t'- State Form 43709(R11/6-09)
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Prescribed by Departmental Local Government Finance
rr File Mark
INSTRUCTIONS: MAR U ' 'n
To be filed in person or by mail with the County Auditor or County Recorder of the county where the property is lotbl Form Ned
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 tfyg/drelye 1 coo s
before March 31 of each year the deduction is sought. GIB Pdf ❑ County Recorder
See reverse side for additional instructions and qualifications. SON COUNTY AUDITOR
Appfipnt(owner or contact buyer )4�L t&,7 reverse
' Key number/legal desoiption Record number Page number
t n} - & :CR o-c 8-/cc - r ,5 / oo I ao/ 3 119k
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 I,current year March 1,anent year date of appli ation legal w equitable amen
- 8togn() ❑ Yes ❑ No
If no,what Is his I her exact share of interest? If owned with someone other than spouse,Indicate with whom
If name on record is different than that of applcant indicate below: Is the property in question:Annually Assessed
'Real Property ❑Annually Assessed 6-1.1-7)
Name of nmrtg(a�@lo��Jorr nntract seller.-
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Address of mortgag oycmbact seller(n uniber/.ynCand street,ray;stare.and LP Dods)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and scree;dry,state,and ZIP code)
Does applicant own property in any other If yes,what county? what Taxing District? Has this deduction been requested on property
county in Indiana? ❑ Yes ❑ No for=rent yeah! ❑ Yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount of:
20 20 20 20 20 20 20
Signature of County Auditor County Date(month,day,year)
I/We 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 I contract buyer of the aforementioned property on date application is filed.
ynatiutet A frnai Date(month,day.year)ZIP code)
Full resident addressor 744.3--t t &bI(S F 11er$� N 4/741-2
Person authorized by duty executed Power of Attorney or by IC 6-1.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street city,state,and ZIP code) .