HomeMy WebLinkAboutMortgage_McGrew (4) STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS County Township Year
FOR DEDUCTION FROM ASSESSED VALUATION
11-- State Form 43709(R11/6-09)
Prescribed by Department of Local Government Finance
File Mark
INSTRUCTIONS: _
To be filed in person or mail with the County Auditor or County Recorder of the county where the property Farm Ned with_
ce by b h ry P Pe b is located.
Filing Dates: f) Real Property Must file during the year for which the deduction is sought. ❑ County Auditor
2) Mobile/Manufactured Homes not assessed as Real Property Must file during the twelve(12)months
before March 3i1 of each year the deduction is sought. - ❑ County Recorder
See reverse side f additional instructions and qualifications.
Applicant(owner or tratdb -SearC onsplreverse side)
131,Disbict Key mbar/legaldesesaiption Record number P e number
o4-as poi- 000 3i oao 7o
ger...iv..of property as of MMoortgage��traa indebtedness unpaid as of Mortgage/Contract indebtedness unpaid as of Is the applicant the sole
Moth 1.current year year date of app&atMnn legal or equitable owner?
8
If no,what is his/her exact share of interest? If owned with someone spouse,indicate with whom
meone other than ❑ Yes ❑ No
If name on record is different than that of appbcanL indicate below: Is the
property in question:Annually Assessed
❑Real Property ❑Annually Assessed
Mobile Home(IC 6-1.1-7)
Name of mortgagee or contract seller //J��//�C� /�
Address of • - a C J
mortgagee or contract seller(number and street city,state.and ZI .ode)
Name of assignee or other owner or holder of mortgage
Address of assignee(number and street,city,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
munty in Indiana? El yes ❑ No for current yeah ❑ yes ❑ No
COUNTY AUDITOR
Deduction approved in the amount at
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/contract buyer of the aforementioned property on date application is filed.
Signature(owners full name) Date(month,day,year)
Full resident address of ap*Trant(number and street,oily,state,and ZIP code)
Person authorized by duly executed Power of Attorney or by IC 61.1-12-0.7 Date(month,day,year)
Address of authorized person (number and street,city,state,and ZIP code) •